Lab Matters Summer 2019 - Page 68

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, 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, IDPH and SHL continue to monitor this LTCF. In the summer of 2018, 66 LAB MATTERS Summer 2019 PublicHealthLabs @APHL Presenter: Emily Snavely, AR Fellow, New York State Department of Health-Wadsworth Center, Albany, NY, 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.