1182. Risk Factors for the Acquisition of IMP-Type Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae in Japan: A Matched Case–control Study

Abstract

BackgroundThe majority of CRE in Japan are IMP-type carbapenemase-producing CRE (IMP-CRE). However, research on risk factors for the acquisition of IMP-CRE has been limited, and questions exist regarding whether IMP-CRE have risk factors similar to other types of CRE such as KPC.MethodsWe conducted a matched case–control study involving patients from whom IMP-CRE had been isolated. The controls were selected among patients with carbapenem susceptible Enterobacteriaceae (CSE). Non-meropenem-susceptible per CLSI criteria and/or ceftazidime-resistant Enterobacteriaceae were screened, and metallo-β-lactamase–positive isolates were examined for blaIMP by PCR (January 2012 to December 2016).ResultsNinety-six patients with CRE were matched with 96 patients with CSE. They comprised Enterobacter sp. (n = 132 [CRE: 66, CSE: 66], 68.8%) and Klebsiella pneumoniae (n = 60 [CRE:30, CSE:30], 31.2%), and bacteria were most commonly isolated from sputum (n = 76 [39.6%]), followed by urine (n = 62 [32.3%]). Background factors such as age (median = 75 [IQR: 66–84]), sex (male = 56.8%), and the Charlson comorbidity index (median = 2 [IQR: 1–3.8]) were similar between CRE and CSE. In multivariate analysis, independent risk factors were identified: history of gastrointestinal (GI) endoscopy or surgery, history of ICU stay, and a previous exposure within 1 month to penicillins with β-lactamase inhibitors, cephalosporines, or carbapabnems.ConclusionHistories of GI endoscopy and ICU stay as well as broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Infection control measures combined with enhanced antimicrobial stewardship are key to preventing the spread of IMP-CRE. Multivariate analysis of risk factors for isolation of IMP-CRE , n (%)VariablesCRE(n = 96)CSE(n = 96)Adjusted odds ratio(95% CI)AdjustedP-valueHistoryGI endoscopy or surgery28 (29)12 (13)3.03 (1.24–7.43)0.015ICU stay32 (33)18 (19)2.25 (1.0–5.04)0.049Device useNasogastric tube43 (45)24 (25)1.27 (0.58–2.78)0.547Urinary catheter59 (61)38 (40)1.66 (0.83–3.33)0.155Tracheotomy18 (19)7 (7)2.17 (0.71–6.59)0.172PEG tube10 (10)3 (3)3.89 (0.74–20.57)0.11Antibiotic exposure ≤1 monthPenicillins with β-lactamase inhibitors52 (54)27 (28)4.54 (2.17–9.49)<0.001Cephalosporines40 (42)19 (20)3.38 (1.54–7.43)0.002Carbapenems25 (26)10 (10)3.08 (1.24–7.66)0.015Disclosures All authors: No reported disclosures.