504. Epidemiology of End-stage Renal Disease (ESRD) Patients with Carbapenem-Resistant Enterobacteriaceae (CRE) Infections: Atlanta Metropolitan Area, 2012–2017

Abstract

BackgroundPatients with end-stage renal disease (ESRD) have higher risks for resistant organisms including carbapenem-resistant Enterobacteriaceae (CRE). To explore the effect of ESRD on CRE, we compared characteristics of CRE cases with and without ESRD in a population-based cohort.MethodsThe Georgia Emerging Infections Program has performed active laboratory- and population-based surveillance for CRE in metropolitan Atlanta (4.1 million in 2017) since 2012. CRE cases are defined by isolation from a sterile body site or urine of E. coli, K. pneumoniae, K. oxytoca, K. aerogenes, or E. cloacae. From 2012 to 2015, cultures were resistant to all third-generation cephalosporins tested and non-susceptible to ≥1 carbapenem (excluding ertapenem). After 2016, cultures were resistant to ≥1 carbapenems. Epidemiologic data including ESRD were collected via medical chart review. ESRD population data were obtained from the US Renal Data System. Georgia vital records data were used to determine 90-day mortality rates. Prevalence estimates were calculated. Comparisons used a χ 2 test.ResultsOf 1,511 CRE cases, 136 (9%) were on current chronic dialysis, 128 (94%) of which were on hemodialysis (HD) and 5 (4%) were on peritoneal dialysis. Among CRE cases with HD, 94 (73%) had a catheter and 30 (23%) had an arteriovenous fistula or graft. CRE cases with ESRD were more likely to be male (58% vs. 40%), black (76% vs. 38%), and have diabetes (67% vs. 38%), congestive heart failure (25% vs. 17%), or peripheral arterial disease (12% vs. 4%). CRE cases with ESRD had more hospitalizations within 30 days of the culture date (77% vs. 47%), ICU admissions prior to (29% vs. 7%) or after the culture date (43% vs. 14%) and discharges to LTCFs (35% vs. 15%) after hospitalization. CRE cases with ESRD and bacteremia were more likely to have been hospitalized >3 days before the culture compared with CRE cases with ESRD and positive cultures from other body sites (52% vs. 24%). The 90-day mortality rate per 100,000 population was higher among CRE cases with ESRD (100.9 cases) than without ESRD (1.0 cases).ConclusionAmong a population-based cohort of patients with CRE infections, ESRD comprised ~10% but had markedly mortality, suggesting that future interventions should target ESRD.Disclosures All authors: No reported disclosures.