731 - The Emergence of Mobile Colistin Resistance (mcr) Genes among Enteric Pathogens in the United States — 2008–2019

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Presenting Author(s)

Farrell A. Tobolowsky

Epidemic Intelligence Service Officer
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Cindy R. Friedman

Team Lead, National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS)
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MR

Matthew Ryan

Master's of Public Health El
Emory
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MB

Meseret Birhane

Epidemiologist
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JC

Jessica Chen

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

Hattie E. Webb

Microbiologist
Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RB

Rachel A. Beukelman

Microbiologist, Principal
Idaho Department of Health and Welfare
Boise, Idaho
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RB

Rick Bokanyi

Laboratory Scientist III
Ohio Department of Health Laboratory
Reynoldburg, Ohio
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

David J. Byrd

Laboratory Manager
Missouri State Public Health Laboratory
Jefferson City, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DC

Diana Connor

Epidemiologist
Hawaii State Department of Health
Honolulu, Hawaii
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SH

Samir Hanna

Medical Epidemiologist
Tennessee Department of Health
Nashville, Tennessee
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AK

Akiko Kimura

Medical Epidemiologist
CDPH
Los Angeles, California
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JM

Jordan L. Mason

Supervisor, Enteric and Waterborne Diseases Unit
Wisconsin Department of Health Services
Madison, Wisconsin
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Sara E. McNamara

Antimicrobial Resistance Epidemiologist
State of Michigan
Lansing, Michigan
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Stephanie Meyer

Supervisor, COVID Epidemiology and Data Unit
Minnesota Department of Health
St. Paul, MN
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
GM

Gary Moet

Clinical Lab Analyst
Iowa State Hygienic Laboratory
Coralville, Iowa
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
QP

Quyen Phan

Epidemiologist
Connecticut Department of Public Health
Hartford, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AR

Amy Robbins

Epidemiologist
New York Department of Health
Albany, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Louise Francois Watkins

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

Background: Colistin, once seldom used clinically, has resurged as a “last resort antibiotic” for multidrug-resistant infections and is still used in animal agriculture in countries outside the United States. During 2015–2018, 8 plasmid-mediated, mobile colistin resistance genes (mcr-1 to mcr-8) were each found in one or more clinical, animal, food, and environmental bacterial sources. We describe the epidemiology of mcr genes in enteric pathogens from US patients.

Methods: State public health laboratories have performed whole-genome sequencing on enteric bacterial pathogens since 2015, and some have sequenced older isolates. We screened sequences of isolates collected through 2019 for mcr genes using a workflow based on ResFinder 3.0. State health officials interviewed patients for clinical and epidemiologic information, including demographics, hospitalization, and travel history.

Results: We identified 41 patient isolates with mcr genes collected from stool, urine, and blood during 2008–2019. These included 37 nontyphoidal Salmonella (31 mcr-1, 6 mcr-3), 2 Vibrio (both mcr-4), and 2 Shiga toxin-producing E. coli (both mcr-1). The median patient age was 34 years (interquartile range: 24–54) and 54% were female. Of 23 patients with comorbidity data, 2 (9%) had immunodeficiency, 2 (9%) had past abdominal surgeries, and 1 (4%) had cancer. Patients sought care at doctor’s offices (46%), emergency rooms (35%), and urgent care clinics (19%); 24% were hospitalized for the enteric illness. None died. Among 36 with information, 35 (97%) travelled internationally in the 12 months before illness; 30 (94%) of 32 traveled in the 7 days before. Only 4 (15%) of 27 had contact with a healthcare setting during their trip; common destinations were the Dominican Republic (35%), Vietnam (24%), Thailand (15%), and China (12%).

Conclusion: The data strongly suggest that many patients acquired infection abroad. Nearly one in four were hospitalized, raising concerns that plasmids carrying mcr genes could spread among patients hospitalized with infections caused by multidrug-resistant pathogens for which colistin is the only available treatment. The acquisition of mcr genes by US travelers highlights the need for a global approach to antimicrobial stewardship.