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
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LAB MATTERS Summer 2018
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