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545 Emergence of Klebsiella pneumoniae Carbapenemase (KPC)-Producing Enterobacteriaceae in Minnesota, 2009-2010

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Kristin M. Shaw, MPH , Minnesota Department of Health, Saint Paul, MN
Jane E. Harper, BSN, MS, CIC , Minnesota Department of Health, Saint Paul, MN
Kate A. Klammer, BS , Minnesota Department of Health, Saint Paul, MN
Anita M. Glennen, BS , Minnesota Department of Health, Saint Paul, MN
Kelly M. Gall, BS , Minnesota Department of Health, Saint Paul, MN
Edwin C. Pereira, MD , Division of Infectious Diseases and International Medicine; Department of Medicine; University of Minnesota, Minneapolis, MN
Aaron DeVries, MD, MPH , Minnesota Department of Health, Saint Paul, MN
Ruth Lynfield, MD , Minnesota Department of Health, Saint Paul, MN
Background: KPC-producing Enterobacteriaceae have emerged in parts of the US over the past 10 years. These highly resistant bacteria are difficult to treat, spread readily in healthcare facilities, and are associated with increased morbidity. The first reported KPC in MN was isolated from a 50-year-old inpatient in Feb. 2009, and was positive by PCR for blaKPC. In March 2009, the MN Dept. of Health (MDH) initiated statewide laboratory-based surveillance for carbapenem-resistant Enterobacteriaceae (CRE). MDH advised MN laboratories to perform a Modified Hodge Test (MHT) on isolates that had elevated MICs for at least 1 carbapenem and to submit all MHT positive isolates to MDH for further characterization.

Objective: To describe the epidemiology of KPC and outcomes of MN residents with KPC-producing Enterobacteriaceae reported to MDH between Feb. 2009 and Oct. 2010.

Methods: MN laboratories submitted MHT positive Enterobacteriaceae isolates to MDH. PCR for blakpc was performed. MDH recommended healthcare facilities follow CDC infection control guidance when CRE were reported. Hospital medical records were reviewed for KPC patients identified between Feb. 2009 and Oct. 2010.

Results: MDH received MHT positive CRE isolates from 70 unique MN residents in healthcare facilities throughout the state. 25 of 70 (36%) were blakpc positive of which 7 (28%) were from the respiratory tract, 9 (36%) urine, 6 (24%) wound, and 3 (12%) blood. blakpc was found in 16 (64%) K. pneumoniae, 6 (24%) Enterobacter cloacae, 2 (8%) K. oxytoca, and 1 (4%) Citrobacter freundii. All 6 E.cloacae were associated with 2 related healthcare facilities. K. oxytoca and C. freundii isolates were recovered from pediatric patients with multiple medical problems and prolonged hospitalizations. blaKPC positive isolates were submitted from laboratories serving acute care hospitals (15 patients), long-term acute care hospitals (7 patients), ambulatory clinics (2 patients), and a long-term care facility (1 patient). 10 (40%) patients were known residents of long-term care or assisted living facilities. Median age for patients with blaKPC positive isolates was 58 years (range 1-90); 48% were male. Of hospitalized patients 14 (93%) had co-morbidities, 14 (93%) had invasive devices at the time of culture, and 14 (93%) had known antibiotic exposure in the previous 3 months. 13 (87%) patients had an ICU stay of which 7 (54%) died with no deaths reported in non-ICU patients. All deaths occurred within 5 months of hospitalization.

Conclusions: The presence of KPC in MN healthcare facilities across the continuum of care is concerning. KPC was found in patients with co-morbidities from a variety of healthcare settings throughout MN. We recommend that all healthcare facilities be vigilant for KPC, particularly in patients with co-morbidities, and that facilities institute infection control measures immediately upon identification.