Lab Matters Summer 2018 | Page 76

APHL 2018 Annual Meeting Poster Abstracts

Infectious Disease to be associated with various outbreaks in the U. S. There was a separate cluster of ST1, which is the most common ST among sporadic disease and environmental Lp globally. Resfinder identified a beta-lactam resistance gene, blaOXA-29, in the ST1 genomes. A BLASTn analysis indicated that this sequence is associated with the Paris strain plasmid( pLPP). Facility B isolates belonged to ST378. The international SBT database showed detection of this ST in Canada and Europe but not yet reported in the US. The strain populations from both facilities appeared to be persistent using wgMLST analysis. A SNP-based typing scheme revealed that although these strains were all closely related, some facility locations had sub-clusters that persisted over time. This work better characterizes Legionella species that colonize hospital plumbing systems and may help inform what actions are needed when Legionella is isolated.

Presenter: Lucy DesJardin, PhD, State Hygienic Laboratory at the University of Iowa, Coralville, IA, Phone: 319.335.4339, Email: lucy-desjardin @ uiowa. edu

Implementing a Real-time Method for Aedes aegypti Surveillance for the Tennessee Department of Health

T. Moore, E. Hassett, A. Rodriguez and A. Moncayo, Tennessee Department of Health, Nashville, TN

In the wake of Zika virus spread, state health departments have sought to understand the mosquito distribution and potential presence of the primary Zika virus vector, Aedes aegypti. Historically, Ae. aegypti has been found through the Southeastern United States; however it is unknown whether this geographical distribution is current. The Tennessee Department of Health( TDH) Vector-borne Diseases Program has been actively engaged in determining the presence of Ae. aegypti through statewide mosquito surveillance in collaboration with county and metro health departments. The current methodology requires the identification of field captured adult mosquitoes and the rearing and identification of laid mosquito eggs in oviposition cups collected from the environment. The challenge faced by the TDH Vector-borne disease program is the time required for rearing of mosquito eggs to adulthood and the poor condition of field captured mosquitoes for identification. To overcome these challenges, the TDH Vector-borne Diseases Program is implementing a mosquito rearing and processing protocol combined with a real-time molecular assay to efficiently identify and confirm the potential presence of Ae. aegypti in the state of Tennessee for this upcoming mosquito trapping season. The new protocol will reduce the rearing and identification process from approximately three weeks down to only a few days. This would ultimately alleviate the work load of a vector surveillance program and allow personnel to increase the amount of oviposition cups collected from the environment, thus maximizing the coverage of surveillance. Additionally, this real-time method can decrease the time-lapse between capture and identification, allowing health departments to more efficiently direct the control of Ae. aegypti in the environment.

Presenter: Thomas Moore, MS, Tennessee Department of Health, Vector-Borne Diseases Program, Nashville, TN, Email: tcmoore07 @ gmail. com

Laboratory Surveillance of Enterobacteriaceae Isolated from Patients in Tennessee

V. Stone 1, N. Smith 2, T. Woodard 1, T. McLemore 1, X. Qian 1, J. Gibson 1, R. Steece 1, M. Kainer 2; 1 Tennessee Department of Health: Laboratory Services, Nashville, TN, 2 Tennessee Department of Health: Healthcare Associated Infections and Antimicrobial Resistance Program, Nashville, TN

Background: Enterobacteriaceae are a common cause of hospitalacquired infections. Laboratory-based surveillance on both a national and local level is critical for monitoring the spread. The objective of this study was to create a state-wide surveillance profile by analyzing the distribution and antimicrobial susceptibility patterns of Enterobacteriaceae throughout Tennessee.

Methods: Isolates were submitted from hospitals and reference laboratories across the state. Antibiotic susceptibility was determined at the TN Department of Health( TDH) Laboratory by Kirby-Bauer disk diffusion. Microbiological data from June to November 2017 were collected from the TDH laboratory information management system and analyzed through WHONET 2017 using current CLSI breakpoints. CRE was defined as an isolate that was resistant to at least one of the carbapenems tested; carbapenemase producing-CRE( CP-CRE) was determined through the modified carbapenem inhibition method( mCIM), followed by resistance mechanism testing using PCR. County of residence was used to determine State regions.

Results: A total of 402 isolates were submitted to the TDH. Enterobacter cloacae, Klebsiella pneumoniae and Escherichia coli were the three most common species. A moderate majority( 39 %) of all isolates came from Middle TN. E. cloacae and K. pneumoniae isolates were more commonly resistant to the antibiotics tested compared to E. coli. There were variations in the frequency of resistance across state regions for some of the antibiotics( imipenem resistance was identified in 20 %, 58.5 % and 80 % of K. pneumoniae isolates from West, Middle and East TN, respectively). A total of 203 isolates were confirmed to be CRE. CP-CRE made up 55 % of the CRE isolates, with the majority( 45 %) coming from East Tennessee. CP-CREs were resistant to more antibiotics compared to non-CP-CRE. For carbapenemase producers, resistance to all of the seven drugs( aztreonam, cefepime, ceftazidime, ceftriaxone, ertapenem, imipenem and meropenem) was identified among E. cloacae( 95.6 %), K. pneumoniae( 90.7 %) and E. coli( 100 %). In contrast, for non-carbapenemase producers, only 15.8 % of E. cloacae, 5.6 % of K. pneumoniae and 22 % of E. coli were resistant to all seven drugs.

Conclusion: There were some variations in the distribution and antimicrobial susceptibility of Enterobacteriaceae across the state. Resistance to the drugs above appeared to be strongly associated with carbapenemase production. These findings suggest creating a regional antibiotic profile may be beneficial for surveillance and infection control guidelines.

Presenter: Victoria Stone, PhD, Tennessee Department of Health: Laboratory Services, Nashville, TN, Phone: 615.262.6462, Email: victoria. stone @ tn. gov