486. Epidemiology of Carbapenem-ResistantPseudomonas aeruginosaIdentified through the Emerging Infections Program (EIP), United States, 2016–2018

作     者：Grass, Julian E Bulens, Sandra N Bamberg, Wendy M Janelle, Sarah J Schutz, Kyle Jacob, Jesse T Bower, Chris W Blakney, Rebekah Wilson, Lucy E Vaeth, Elisabeth Li, Linda Lynfield, Ruth Snippes Vagnone, Paula Dobbins, Ginette Phipps, Erin C Hancock, Emily B Dumyati, Ghinwa Tsay, Rebecca Cassidy, P Maureen West, Nicole Kainer, Marion A Mounsey, Jacquelyn Stanton, Richard A McAllister, Gillian A Campbell, Davina Lutgring, Joseph D Karlsson, Maria Walters, Maroya S 

作者机构：Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia Colorado Department of Public Health and Environment Denver Colorado Emory University Atlanta Georgia Georgia Emerging Infections Program Decatur Georgia University of Maryland Baltimore County Baltimore Maryland Maryland Department of Health Baltimore Maryland Minnesota Department of Health Saint Paul Minnesota Minnesota Department of Health Laboratory St. Paul Minnesota University of New Mexico Albuquerque New Mexico New York Rochester Emerging Infections Program at the University of Rochester Medical Center Rochester New York Oregon Health Authority Portland Oregon Tennessee Department of Health Nashville Tennessee Centers for Disease Control and Prevention Atlanta Georgia 

出 版 物：《Open Forum Infectious Diseases》 

年 卷 期：2019年第6卷第SUPPLEMENT_2期

页      面：S238–S238页

摘      要：Background Pseudomonas aeruginosa is intrinsically resistant to many commonly used antimicrobials, and carbapenems are often required to treat infections. We describe the crude incidence, epidemiology, and molecular characteristics of carbapenem-resistant P. aeruginosa (CRPA) in the EIP catchment area. Methods From August 1, 2016 through July 31, 2018, we conducted laboratory- and population-based surveillance for CRPA in selected areas in eight sites. We defined a case as the first isolate of P. aeruginosa resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period. Patient charts were reviewed. Analysis excluded cystic fibrosis patients. A random sample of isolates was collected. Real-time PCR to detect carbapenemase genes and whole-genome sequencing are in progress. Results We identified 4,209 cases in 3373 patients. The annual incidence was 14.50 (95% CI, 14.07–14.94) per 100,000 persons and varied among sites from 4.89 in OR to 25.21 in NY. The median age of patients was 66 years (range: 1–101), 42.1% were female, and nearly all (97.5%) had an underlying condition. Most cases were identified from urine (42.8%) and lower respiratory tract (35.7%) cultures. Nearly all (93.3%) occurred in patients with inpatient healthcare facility stay, surgery, chronic dialysis, or indwelling devices in the prior year; death occurred in 7.2%. Among 937 isolates tested, 847 (90.4%) underwent PCR; six (0.7%) harbored a carbapenemase, from four sites (CO, MD, NY, and OR): bla VIM (3), bla KPC (2), and bla IMP (1). Of 612 (65.3%) isolates sequenced, the most common ST types were ST235 (9.2%) and ST298 (4.9%). Conclusion Carbapenemases were rarely the cause of carbapenem resistance but were found at EIP sites with high and low CRPA incidence. The emergence of mobile carbapenemases in P. aeruginosa has the potential to increase the incidence of CRPA.