2487. Which Extended-Spectrum β-Lactamase-Producing Enterobacterales Colonize the Gastrointestinal Tract of High-Risk Patients?
Abstract Background The epidemic of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) continues to expand. ESBL-Es commonly colonize the intestinal tract and may propagate the spread of ESBL genes. However, the frequency at which ESBL production occurs in all Enterobacterales (includ...
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description | Abstract
Background
The epidemic of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) continues to expand. ESBL-Es commonly colonize the intestinal tract and may propagate the spread of ESBL genes. However, the frequency at which ESBL production occurs in all Enterobacterales (including inducible AmpC-producers) is unknown. This study aims to define the epidemiology of third-generation cephalosporin resistant Enterobacterales (3GC-RE) colonization to understand their burden and contribution to ESBL spread in high-risk populations (e.g., ICU, oncology, transplant).
Methods
Surveillance cultures for 3GC-RE were performed by collecting perirectal swabs among high-risk populations at The Johns Hopkins Hospital. Isolates were identified by MALDI-TOF MS after recovery on 3GC selective chromogenic media. Antimicrobial susceptibility testing was performed using lyophilized broth microdilution panels following Clinical and Laboratory Standards Institute (CLSI) guidelines. 3GC-RE were characterized using the CLSI ESBL disk test among recommended Enterobacterales. For inducible AmpC-producing Enterobacterales, cefepime +/- clavulanic acid disk test was performed. Carbapenem-resistant Enterobacterales (CRE) were tested for carbapenemase-production using the modified carbapenem inactivation method (mCIM) and by the CARBA 5 lateral flow assay, if mCIM positive.
Results
Of 966 surveillance cultures, 99 (10%) were positive for 3GC-RE and 14 (1%) were positive for CRE. Almost all 112 (99%) rectal swabs had a single organism isolated while multiple organisms were isolated from 1 (1%). 114 bacterial isolates were recovered (Table 1). Of the 3GC-RE, 66 (58%) were ESBL-producers with Escherichia coli, Klebsiella pneumoniae and K. oxytoca being the most common ESBL-E. Additionally, 14 (12%) were CRE with K. pneumoniae, E. coli and Enterobacter cloacae complex being the most common CRE. Of CRE, 7 (50%) were carbapenemase producers with 4 (57%) KPC, 2 (29%) NDM and 1 (14%) KPC and NDM.
Conclusion
Colonization with 3GC-RE and CRE occurs in 10% and 1% of rectal swabs collected from high-risk patients, respectively. 58% of 3GC-RE were ESBL producers and ranged between 0-100% among 3GC-RE; including up to 33% from inducible AmpC producing Enterobacterales.
Disclosures
Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Patricia J. Simner, PhD, Affinity Biosensors: Grant/Research Support|BD Diagnostics: Advisor/ |
doi_str_mv | 10.1093/ofid/ofad500.2105 |
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Background
The epidemic of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) continues to expand. ESBL-Es commonly colonize the intestinal tract and may propagate the spread of ESBL genes. However, the frequency at which ESBL production occurs in all Enterobacterales (including inducible AmpC-producers) is unknown. This study aims to define the epidemiology of third-generation cephalosporin resistant Enterobacterales (3GC-RE) colonization to understand their burden and contribution to ESBL spread in high-risk populations (e.g., ICU, oncology, transplant).
Methods
Surveillance cultures for 3GC-RE were performed by collecting perirectal swabs among high-risk populations at The Johns Hopkins Hospital. Isolates were identified by MALDI-TOF MS after recovery on 3GC selective chromogenic media. Antimicrobial susceptibility testing was performed using lyophilized broth microdilution panels following Clinical and Laboratory Standards Institute (CLSI) guidelines. 3GC-RE were characterized using the CLSI ESBL disk test among recommended Enterobacterales. For inducible AmpC-producing Enterobacterales, cefepime +/- clavulanic acid disk test was performed. Carbapenem-resistant Enterobacterales (CRE) were tested for carbapenemase-production using the modified carbapenem inactivation method (mCIM) and by the CARBA 5 lateral flow assay, if mCIM positive.
Results
Of 966 surveillance cultures, 99 (10%) were positive for 3GC-RE and 14 (1%) were positive for CRE. Almost all 112 (99%) rectal swabs had a single organism isolated while multiple organisms were isolated from 1 (1%). 114 bacterial isolates were recovered (Table 1). Of the 3GC-RE, 66 (58%) were ESBL-producers with Escherichia coli, Klebsiella pneumoniae and K. oxytoca being the most common ESBL-E. Additionally, 14 (12%) were CRE with K. pneumoniae, E. coli and Enterobacter cloacae complex being the most common CRE. Of CRE, 7 (50%) were carbapenemase producers with 4 (57%) KPC, 2 (29%) NDM and 1 (14%) KPC and NDM.
Conclusion
Colonization with 3GC-RE and CRE occurs in 10% and 1% of rectal swabs collected from high-risk patients, respectively. 58% of 3GC-RE were ESBL producers and ranged between 0-100% among 3GC-RE; including up to 33% from inducible AmpC producing Enterobacterales.
Disclosures
Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Patricia J. Simner, PhD, Affinity Biosensors: Grant/Research Support|BD Diagnostics: Advisor/Consultant|BD Diagnostics: Grant/Research Support|Entasis: Advisor/Consultant|GeneCapture: Stocks/Bonds|Merck: Advisor/Consultant|OpGen Inc: Board Member|OpGen Inc: Grant/Research Support|OpGen Inc: Honoraria|Qiagen Sciences Inc: Advisor/Consultant|Qiagen Sciences Inc: Grant/Research Support|Shionogi Inc: Advisor/Consultant|T2 Biosystems: Grant/Research Support</description><identifier>ISSN: 2328-8957</identifier><identifier>EISSN: 2328-8957</identifier><identifier>DOI: 10.1093/ofid/ofad500.2105</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>Open forum infectious diseases, 2023-11, Vol.10 (Supplement_2)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,864,27924,27925</link.rule.ids></links><search><creatorcontrib>Stambaugh, Haley</creatorcontrib><creatorcontrib>Lewis, Shawna</creatorcontrib><creatorcontrib>Jacobs, Emily B</creatorcontrib><creatorcontrib>Hareza, Dariusz A</creatorcontrib><creatorcontrib>Bergman, Yehudit</creatorcontrib><creatorcontrib>Cosgrove, Sara E</creatorcontrib><creatorcontrib>Tamma, Pranita</creatorcontrib><creatorcontrib>Simner, Patricia J</creatorcontrib><title>2487. Which Extended-Spectrum β-Lactamase-Producing Enterobacterales Colonize the Gastrointestinal Tract of High-Risk Patients?</title><title>Open forum infectious diseases</title><description>Abstract
Background
The epidemic of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) continues to expand. ESBL-Es commonly colonize the intestinal tract and may propagate the spread of ESBL genes. However, the frequency at which ESBL production occurs in all Enterobacterales (including inducible AmpC-producers) is unknown. This study aims to define the epidemiology of third-generation cephalosporin resistant Enterobacterales (3GC-RE) colonization to understand their burden and contribution to ESBL spread in high-risk populations (e.g., ICU, oncology, transplant).
Methods
Surveillance cultures for 3GC-RE were performed by collecting perirectal swabs among high-risk populations at The Johns Hopkins Hospital. Isolates were identified by MALDI-TOF MS after recovery on 3GC selective chromogenic media. Antimicrobial susceptibility testing was performed using lyophilized broth microdilution panels following Clinical and Laboratory Standards Institute (CLSI) guidelines. 3GC-RE were characterized using the CLSI ESBL disk test among recommended Enterobacterales. For inducible AmpC-producing Enterobacterales, cefepime +/- clavulanic acid disk test was performed. Carbapenem-resistant Enterobacterales (CRE) were tested for carbapenemase-production using the modified carbapenem inactivation method (mCIM) and by the CARBA 5 lateral flow assay, if mCIM positive.
Results
Of 966 surveillance cultures, 99 (10%) were positive for 3GC-RE and 14 (1%) were positive for CRE. Almost all 112 (99%) rectal swabs had a single organism isolated while multiple organisms were isolated from 1 (1%). 114 bacterial isolates were recovered (Table 1). Of the 3GC-RE, 66 (58%) were ESBL-producers with Escherichia coli, Klebsiella pneumoniae and K. oxytoca being the most common ESBL-E. Additionally, 14 (12%) were CRE with K. pneumoniae, E. coli and Enterobacter cloacae complex being the most common CRE. Of CRE, 7 (50%) were carbapenemase producers with 4 (57%) KPC, 2 (29%) NDM and 1 (14%) KPC and NDM.
Conclusion
Colonization with 3GC-RE and CRE occurs in 10% and 1% of rectal swabs collected from high-risk patients, respectively. 58% of 3GC-RE were ESBL producers and ranged between 0-100% among 3GC-RE; including up to 33% from inducible AmpC producing Enterobacterales.
Disclosures
Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Patricia J. Simner, PhD, Affinity Biosensors: Grant/Research Support|BD Diagnostics: Advisor/Consultant|BD Diagnostics: Grant/Research Support|Entasis: Advisor/Consultant|GeneCapture: Stocks/Bonds|Merck: Advisor/Consultant|OpGen Inc: Board Member|OpGen Inc: Grant/Research Support|OpGen Inc: Honoraria|Qiagen Sciences Inc: Advisor/Consultant|Qiagen Sciences Inc: Grant/Research Support|Shionogi Inc: Advisor/Consultant|T2 Biosystems: Grant/Research Support</description><issn>2328-8957</issn><issn>2328-8957</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNqNkMFKAzEQhoMoWGofwFsewNRJ0uxmTyKltkLBohWPS5pku9HtpiQpqCefyQfxmdzSHjx6mRn4v38OH0KXFIYUCn7tK2e6oYwAGDIK4gT1GGeSyELkp3_uczSI8RUAaAdBXvTQFxvJfIhfaqdrPHlPtjXWkKet1SnsNvjnm8yVTmqjoiWL4M1Ou3aNJ22ywa-6xAbV2IjHvvGt-7Q41RZPVUzBu46JybWqwcvQkdhXeObWNXl08Q0vVHK2TfHmAp1Vqol2cNx99Hw3WY5nZP4wvR_fzommjAkiFWiejeiK8aywIpOMgc4yqGhuQI-KDHKe6w7hkjNqOBRCVTKXUvFMcKF4H9HDXx18jMFW5Ta4jQofJYVyb7HcWyyPFsu9xa5zdej43fYf-C9Ci3Y7</recordid><startdate>20231127</startdate><enddate>20231127</enddate><creator>Stambaugh, Haley</creator><creator>Lewis, Shawna</creator><creator>Jacobs, Emily B</creator><creator>Hareza, Dariusz A</creator><creator>Bergman, Yehudit</creator><creator>Cosgrove, Sara E</creator><creator>Tamma, Pranita</creator><creator>Simner, Patricia J</creator><general>Oxford University Press</general><scope>TOX</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20231127</creationdate><title>2487. Which Extended-Spectrum β-Lactamase-Producing Enterobacterales Colonize the Gastrointestinal Tract of High-Risk Patients?</title><author>Stambaugh, Haley ; Lewis, Shawna ; Jacobs, Emily B ; Hareza, Dariusz A ; Bergman, Yehudit ; Cosgrove, Sara E ; Tamma, Pranita ; Simner, Patricia J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1225-8a0c3641b2369e568220c660f17d0c4960737cc3638321d3095af8788a36535a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stambaugh, Haley</creatorcontrib><creatorcontrib>Lewis, Shawna</creatorcontrib><creatorcontrib>Jacobs, Emily B</creatorcontrib><creatorcontrib>Hareza, Dariusz A</creatorcontrib><creatorcontrib>Bergman, Yehudit</creatorcontrib><creatorcontrib>Cosgrove, Sara E</creatorcontrib><creatorcontrib>Tamma, Pranita</creatorcontrib><creatorcontrib>Simner, Patricia J</creatorcontrib><collection>Oxford Open</collection><collection>CrossRef</collection><jtitle>Open forum infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stambaugh, Haley</au><au>Lewis, Shawna</au><au>Jacobs, Emily B</au><au>Hareza, Dariusz A</au><au>Bergman, Yehudit</au><au>Cosgrove, Sara E</au><au>Tamma, Pranita</au><au>Simner, Patricia J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>2487. Which Extended-Spectrum β-Lactamase-Producing Enterobacterales Colonize the Gastrointestinal Tract of High-Risk Patients?</atitle><jtitle>Open forum infectious diseases</jtitle><date>2023-11-27</date><risdate>2023</risdate><volume>10</volume><issue>Supplement_2</issue><issn>2328-8957</issn><eissn>2328-8957</eissn><abstract>Abstract
Background
The epidemic of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) continues to expand. ESBL-Es commonly colonize the intestinal tract and may propagate the spread of ESBL genes. However, the frequency at which ESBL production occurs in all Enterobacterales (including inducible AmpC-producers) is unknown. This study aims to define the epidemiology of third-generation cephalosporin resistant Enterobacterales (3GC-RE) colonization to understand their burden and contribution to ESBL spread in high-risk populations (e.g., ICU, oncology, transplant).
Methods
Surveillance cultures for 3GC-RE were performed by collecting perirectal swabs among high-risk populations at The Johns Hopkins Hospital. Isolates were identified by MALDI-TOF MS after recovery on 3GC selective chromogenic media. Antimicrobial susceptibility testing was performed using lyophilized broth microdilution panels following Clinical and Laboratory Standards Institute (CLSI) guidelines. 3GC-RE were characterized using the CLSI ESBL disk test among recommended Enterobacterales. For inducible AmpC-producing Enterobacterales, cefepime +/- clavulanic acid disk test was performed. Carbapenem-resistant Enterobacterales (CRE) were tested for carbapenemase-production using the modified carbapenem inactivation method (mCIM) and by the CARBA 5 lateral flow assay, if mCIM positive.
Results
Of 966 surveillance cultures, 99 (10%) were positive for 3GC-RE and 14 (1%) were positive for CRE. Almost all 112 (99%) rectal swabs had a single organism isolated while multiple organisms were isolated from 1 (1%). 114 bacterial isolates were recovered (Table 1). Of the 3GC-RE, 66 (58%) were ESBL-producers with Escherichia coli, Klebsiella pneumoniae and K. oxytoca being the most common ESBL-E. Additionally, 14 (12%) were CRE with K. pneumoniae, E. coli and Enterobacter cloacae complex being the most common CRE. Of CRE, 7 (50%) were carbapenemase producers with 4 (57%) KPC, 2 (29%) NDM and 1 (14%) KPC and NDM.
Conclusion
Colonization with 3GC-RE and CRE occurs in 10% and 1% of rectal swabs collected from high-risk patients, respectively. 58% of 3GC-RE were ESBL producers and ranged between 0-100% among 3GC-RE; including up to 33% from inducible AmpC producing Enterobacterales.
Disclosures
Sara E. Cosgrove, MD, MS, Debiopharm: Advisor/Consultant|Duke Clinical Research Institute: Advisor/Consultant Patricia J. Simner, PhD, Affinity Biosensors: Grant/Research Support|BD Diagnostics: Advisor/Consultant|BD Diagnostics: Grant/Research Support|Entasis: Advisor/Consultant|GeneCapture: Stocks/Bonds|Merck: Advisor/Consultant|OpGen Inc: Board Member|OpGen Inc: Grant/Research Support|OpGen Inc: Honoraria|Qiagen Sciences Inc: Advisor/Consultant|Qiagen Sciences Inc: Grant/Research Support|Shionogi Inc: Advisor/Consultant|T2 Biosystems: Grant/Research Support</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/ofid/ofad500.2105</doi><oa>free_for_read</oa></addata></record> |
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title | 2487. Which Extended-Spectrum β-Lactamase-Producing Enterobacterales Colonize the Gastrointestinal Tract of High-Risk Patients? |
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