METHODS: We defined a case as isolation of CRE from any specimen collected during March 1, 2015–February 28, 2016 from a patient ≥ one year of age during an in-patient stay at a participating hospital. We developed a case report form and hospital-based public health epidemiologists submitted clinical, exposure and laboratory information for each case via a web-based interface. We requested submission of one isolate per case and conducted molecular testing for common resistance mechanisms on all submitted isolates.
RESULTS: As of November 2015, 114 cases have been identified, 63 (55%) of which were associated with clinical infections. The most common infections were urinary tract (n=21), pneumonia (n=9), skin or other abscesses (n=7) and bacteremia or sepsis (n=7). Among patients from whom CRE were isolated, half were male (50%). The majority of patients were white (53%) and aged 45−64 years (52%). Twenty patients (18%) had a known history of CRE infection or colonization. Forty-one (36%) patients were admitted directly from another facility. Thirty-six (32%) had a history of residence in a long-term care facility. During the 90 days before specimen collection, 93 patients (82%) had received antibiotics, and 99 (87%) had one or more indwelling devices or surgical procedures. These included central lines (n=67), endotracheal tubes (n=51), gastrostomy tubes (n=24) and endoscopy procedures (n=19). Among the 86 (75%) cases with corresponding isolates submitted, 54 (63%) tested positive for Klebsiella pneumoniae carbapenemase (KPC). One (1%) tested positive for New Delhi Metallo-beta-lactamase (NDM); this patient had undergone surgical procedures in India. Thirty-one isolates (36%) tested negative for both KPC and NDM.
CONCLUSIONS: The majority of patients from whom CRE was isolated had recent healthcare exposures including hospitalizations, indwelling devices and antibiotics. The majority of CRE isolates (63%) tested positive for KPC, the most common mechanism of carbapenem resistance nationally. These results will be used for future antimicrobial resistance prevention activities and program planning as we consider incorporating CRE as a reportable condition in NC.