509. The Prevalence of Carbapenem-Resistant Enterobacteriaceae (CRE) in a Community Hospital Setting

Abstract

BackgroundCarbapenems are bactericidal β-lactam antibiotics with a wide spectrum of antimicrobial activity. The emergence of carbapenem resistance, specifically carbapenem-resistant enterobacteriaceae (CRE), has left few viable treatment options. Multiple factors contribute to overutilization of carbapenems. At Union Hospital, in Terre Haute, Indiana, carbapenems are utilized for patients with a documented anaphylactic allergy to penicillins and cephalosporins and are the drug of choice for the treatment of ESBL infections. The overuse and inappropriate use of carbapenems plus increasing resistance has contributed to the development of CRE and other multi-drug-resistant organisms. Thus, an examination of resistance patterns was conducted at a smaller level in a community hospital.MethodsA retrospective analysis was conducted to examine carbapenem resistance patterns at Union Hospital. Patients with a CRE diagnosis from June 2017 to July 2018 were included. Data analysis examined baseline characteristics, culture site, presence of carbapenamase production, treatment agent, and patient outcome. An assessment of true infection vs. colonization was conducted for all positive CRE cultures.ResultsFifty-three patients were identified with a culture-proven CRE diagnosis. CRE was isolated from the following sites: urine, sputum, bronchial wash, blood, and tissue/wound culture. True infection was identified in 32 cases. For the 18 cases with likely colonization, urine was the most common site. Klebsiella pneumoniae was the most common organism identified with carbapenem-resistance. Fluoroquinolones, either alone or in combination with other agents, were the most commonly used agents to treat CRE infection. The average duration of targeted antibiotic therapy was 9 days. Mortality rates at 30 and 90 days were 10% and 14%, respectively.ConclusionThe prevalence of CRE infections is on the rise, and may be a result of increased broad-spectrum antibiotic use combined with inappropriate carbapenem use. Unconventional agents, such as fluoroquinolones, are being utilized to manage patients with documented CRE infection at Union Hospital.Disclosures All authors: No reported disclosures.