918 - Pilot Surveillance for Carbapenemase Gene-positive Organisms Among Hospitalized Solid Organ Transplant Recipients

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Presenting Author(s)

June L. Chan

Antimicrobial Resistance Postdoctoral Fellow
Wadsworth Center/NYSDOH/APHL
Albany, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

EN

Elizabeth Nazarian

Research Scientist
Wadsworth
Albany, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KM

Kimberlee A. Musser

Chief
Wadsworth Center, New York State Department of Health
Albany, NY
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Monica Fung

Assistant Professor, Infectious Diseases
UCSF
San Fransisco, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Sarah B. Doernberg

Associate Professor
University of California, San Francisco
San Francisco, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Stephanie M. Pouch

Associate Professor
Emory University School of Medicine
Atlanta, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Surbhi Leekha

Professor
University of Maryland School of Medicine
Baltimore, MD
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Judith A. Anesi

Instructor of Medicine
University of Pennsylvania
Philadelphia, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RK

Rosy Priya Kodiyanplakkal

Assistant Professor of Clinical Medicine
Weill Cornell Medicine, NewYork-Presbyterian Hospital
New York, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Sarah Turbett

Associate Director, Clinical Microbiology Laboratories Assistant in Medicine, Division of Infectious Diseases
Massachusetts General Hospital
Boston, MA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MS

Maroya Spalding Walters

Lead, Antimicrobial Resistance Team
U.S. Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LE

Lauren Epstein

Medical Officer
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Carbapenemase gene-positive organisms (CPOs) are associated with infections with high mortality rates and have the potential to facilitate epidemic spread of carbapenem resistance. Passive reporting to CDC identified CPOs among organ transplant recipients, potentially representing an emerging reservoir for spread. We aimed to determine the prevalence of CPOs in hospital units where solid organ transplant (SOT) recipients receive care in order to inform public health action to prevent transmission.

Methods: All healthcare facilities identified one medical unit where SOT recipients received inpatient care and conducted point prevalence surveys (PPS) of all consenting patients on 1-2 designated calendar days. We used the Cepheid Xpert^® Carba-R assay to identify carbapenemase genes (bla_KPC, bla_NDM, bla_VIM, bla_IMP, bla_OXA-48) from rectal swabs; carbapenemase-positive swabs were cultured for organisms. All laboratory testing was conducted at the Wadsworth Center, part of CDC’s Antibiotic Resistance Laboratory Network.

Results: Five participating hospitals performed nine PPS from September 2019 through June 2020. In total, 154 patients were screened and 92 (60%) were SOT recipients (Table). The most common transplanted organs were kidney (44, 48%) and liver (39, 42%). Carbapenemase genes were detected among 5 (5%) SOT recipients, all from a single healthcare facility; 4 (80%) were bla_KPCand 1 (20%) was bla_NDM. Of the positive specimens cultured, bla_KPC was carried by Enterobacter cloacae complex (ECC), Klebsiella pneumoniae, and Klebsiella oxytoca and bla_NDM was carried by K. oxytoca; bla_KPCwas carried by both ECC and K. pneumoniae in a single individual. For SOT patients with CPOs, the median interval from transplantation to swab collection was 108 days (range: 12 to 323). CPOs were only detected in 1 (2%) of 62 non-transplant patients.TABLE: Characteristics of Carbapenemase Gene-positive Organism (CPO) Pilot Surveillance Participants

Conclusion: Among participating facilities, most did not identify CPOs among patients admitted to transplant units. These findings represent a small number of patients and facilities; additional PPS in areas with varied CPO epidemiology are needed to understand whether SOT recipients should be routinely screened for CPOs.