414. Detection of Colonized Patients with Organisms Resistant to Carbapenems by a Fast Molecular Method at a Hospital in Nicaragua.

Abstract

Abstract Background The resistance to carbapenems has significant implications regard the clinical outcomes of the patients. Strategies to detect colonized patients with carbapenems-resistant organisms are useful to start isolation measures to prevent intrahospital transmission. GeneXpert Carba-R is a fast molecular test to detect rectal colonization by this type of microorganisms. The aim of this study was to detect colonized patients transferred from other countrywide hospitals in Nicaragua, to have an epidemiological panorama of the circulation of genes that confers resistance to carbapenems. Methods This is a retrospective cohort study in a referral hospital (Hospital Dr. Fernando Vélez Paiz) in Managua, Nicaragua. The period of the study was between January 2020 and October 2020. Patients referred to our ICU that had been stayed more than 48 hours in the originating health-care center were recruited. Rectal swab were processed by GeneXpert Carba-R to identify any of the genes of resistance (NDM, KPC, VIM, IMP, OXA-48). An association between colonization and clinical outcomes was evaluated. Results Eighty-nine patients were included in the study and 27 (30.3%) of them had a positive test of Xpert Carba-R. In four patients more than one gene was detected. The most frequent gene detected was NDM (66.6%). Other detected genes were VIM and KPC. Patients colonized with this kind of microorganims were identified coming from 9 countrywide hospitals and from 6 hospitals of the capital city (Managua). Independent risk factors for colonization by organisms resistant to carbapenems were previous exposition to this class of antibiotic (OR: 9.82; CI95%: 3.29-29.30) and qSOFA ≥ 2 points at the admission (OR: 7.36; CI95%: 2.60-20.76). The mortality in the colonized patients was 33.3% vs 9.6% in the control group (p=0.006), with an odds ratio of 4.6 (CI95%: 1.46-14.90). Map of Nicaragua showing the wide distribution of the detection of genes conferring resistance to carbapenems in patients referred to Hospital Dr. Fernando Vélez Paiz in the capital city of Managua. Conclusion The prevalence of rectal colonization by organisms resistant to carbapenems in patients transferred to a referral hospital in Nicaragua is high. The most frequent gene detected was NDM. There are presence of these genes in countrywide hospitals. The previous use of carbapenems and the severity of the illness at the admission were risk factors for colonization. To be colonized with this microorganism increased the risk to die. Disclosures All Authors: No reported disclosures.