APHL 2019 POSTER ABSTRACTS
acquired AR genes associated with aminoglycoside, beta-lactam,
fluoroquinolone, and fosfomycin resistance. WGS analysis identified
23 VIM-CRPA isolates as one sequence type, with the blaVIM-2
resistance gene located on a previously characterized class I
integron, In59.2. Of the 23 isolates, 18 formed a cluster with
SNP differences suggesting they may be distantly related but still
share a common source. A subcluster of 9/18 isolates were 0-4
SNPs different from each other, indicating they are very closely
related. Parallel epidemiologic investigation identified 14 affected
individuals who received care at the same outpatient urology clinic.
An onsite visit identified practices inconsistent with standards of
infection control. Isolates from 6/14 individuals belonged to the
subcluster of 9 closely related isolates.
Conclusion: Prior to this study, VIM-CRPA had been rarely identified
in the Northeast region. Our investigation identified a previously
unrecognized cluster of closely related strains amongst isolates
that were not related to a recent common exposure but may share
a distant common ancestor. WGS has informed the epidemiologic
investigation by confirming relatedness between individuals. Overall,
our analyses provided extra resolution when characterizing the
isolates and determining relatedness. The combination of tools
we used in this investigation can be applied to other AR organisms
more commonly seen in the Northeast region.
An Outbreak of blaIMP-27 at a Nursing Home in Iowa
R. Jepson 1 , A. Garvey 2 , M. Pentella 1 , C. Pedati 2 , N. Wilde 2 ; 1 State
Hygienic Laboratory at the University of Iowa, 2 Iowa Department of
Public Health
IMP-27 is a novel Metallo-Beta-lactamase found amongst the
carbapenem-resistant Enterobacteriaceae (CRE). CDC recognizes CRE
to be one of the top three urgent antibiotic resistance threats in the
United States. In 2016, the CDC established the Antibiotic Resistance
Laboratory Network (ARLN) and provided funding to establish
confirmatory testing for CRE. That same year, the Iowa Department
of Public Health (IDPH) designated CRE infection or colonization as
a reportable disease and worked with the State Hygienic Laboratory
(SHL) to develop submission criteria for potential CRE. In March of
2017, an astute laboratorian at a healthcare facility in Iowa reported
an unusually resistant Proteus mirabilis isolated from a urine culture.
The organism was sent to SHL for further characterization. At SHL,
the isolate tested negative for all gene targets using the GeneXpert
Carba-R. The isolate was then sent to CDC where testing revealed
that the Proteus mirabilis was carrying the blaIMP-27 plasmid.
This resistant pathogen was reported to epidemiologists at IDPH.
IDPH directed the healthcare facility all resistant isolates of Proteus
mirabilis SHL. Seven resistant isolates confirmed to be CRE from
March 2017 to October 2018. From six patients there were six
isolates from urine cultures, one from a wound culture and one from
a blood culture. Epidemiologic investigation discovered that most
patients resided in a nearby long-term care facility (LTCF). As part
of the investigation, CRE colonization screening using rectal swabs
detected two additional patients colonized with Proteus mirabilis
bla IMP27. No source in the LTCF was found but infection control
recommendations were made.
To our knowledge, this is the first outbreak caused by IMP-27 carrying
Proteus mirabilis. Prior to this outbreak, there were only two other
cases reported in the United States: one case from an Iowa resident
in 2015 and the other from a resident of North Dakota in 2009.
Presenter: Michael Pentella, State Hygienic Laboratory at the
University of Iowa, Coralville, IA, [email protected]
VIM–CRPA in West Texas: Conducting the First Antibiotic
Resistance Laboratory Network Multi-Site Epi-Aid in the
United States
A. Hoffman, G. Blackwell, T. Dang and C. Wang, Texas Department of
State Health Services
Background: The Texas Department of State Health Services (DSHS)
Antibiotic Resistance Laboratory Network (ARLN) has tested over
255 Carbapenem-resistant Pseudomonas aeruginosa (CRPA)
isolates from West Texas during June 2017 to October 2018. 31 of
those isolates tested positive for the carbapenemase VIM (Verona
Integron-Mediated Metallo-β-lactamase), which accounts for nearly
one-third of the known cases in the United States. Facilities in
West Texas voluntarily submitted certain isolates to the ARLN for
antibiotic resistance mechanism testing. The positive isolates were
from urine, sputum, wound, tissue, and respiratory sources. On
October 8, 2018, the Centers for Disease Control and Prevention
began an Epi-Aid investigation in West Texas due to the continued
positive results without an identifiable source.
Methods: During the Epi-Aid, medical records were reviewed for risk
factors, and patients who received outpatient care were interviewed.
Pulsed-field gel electrophoresis (PFGE) and whole genome
sequencing (WGS) were performed on all VIM-CRPA isolates. Site
visits were conducted at multiple healthcare facilities in West Texas
where case patients received healthcare; these visits included
infection prevention assessments, consultations, and point-
prevalence surveys to assess for the presence of VIM within the
facilities. Point-prevalence surveys were implemented by obtaining
specimens via rectal swabs from 265 patients in seven facilities.
Results: Thirty-one VIM-CRPA isolates have been identified from
West Texas during June 2017 to October 2018. PFGE revealed
15 unique patterns: seven isolates share a common pattern
and two clusters of three isolates share other patterns. WGS
showed that West Texas VIM-CRPA is unique to the region. Point-
prevalence surveys did not identify any additional VIM-positive
patients. Infection control gaps identified included hand hygiene,
environmental cleaning, and communication during transfers
between healthcare facilities.
Conclusions: The VIM-CRPA outbreak in West Texas is unique to the
area and is characterized by genetically-related cases occurring
across multiple closely-connected healthcare facilities. There is
currently no identifiable reservoir. A regional containment strategy is
being developed and implemented to further contain this outbreak.
Presenter: Abby Hoffman, AR Fellow, Texas Department of State
Health Services, Austin, TX, [email protected]
IDPH and SHL continue to monitor this LTCF. In the summer of 2018,
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Presenter: Emily Snavely, AR Fellow, New York State
Department of Health-Wadsworth Center, Albany, NY,
[email protected]
SHL confirmed that five isolates matched using whole-genome
sequencing (WGS). Whole-genome sequencing was completed using
the Illumina 600 cycle MiSeq Reagent kit. Antibiotic resistance genes
were identified and characterized using FDA GalaxyTrakr server.