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Background Carbapenem-resistant Enterobacterales (CREs) and some Carbapenem-resistant organisms (CROs) are considered urgent threats by the CDC. Since 2017, the Alameda County Public Health Department has mandated the reporting of CRE and encouraged voluntary reporting of non-CRE CROs. Surveillance data from these cases were analyzed to describe the epidemiology of infections and to target local public health interventions. Methods Healthcare facilities in Alameda County reported cases of CROs to the public health department directly to staff or through Electronic Laboratory Reporting and submitted isolates to the public health laboratory for ascertainment of carbapenemase genes by whole genome sequencing on the Illumina MiSeq platform; deaths were recorded via the California Electronic Death Registration System. Surveillance data were analyzed for cases July 2019 – June 2021 identified by the clinical laboratory as resistant to one or more carbapenems. Results From July 2019 – June 2021, 444 cases of CROs were reported to Alameda County from 409 patients. The county case rate for CROs over the two-year period was 29 cases per 100,000 population. Of the reported cases, 218 (49%) were CRE species: Escherichia coli, Klebsiella spp., and Enterobacter spp. Of the remaining cases, 157 (35%) were carbapenem-resistant Pseudomonas aeruginosa, 46 (10%) were carbapenem-resistant Acinetobacter baumannii (CRAB), and 23 (5%) were other carbapenem-resistant species. Cases by carbapenemase status are described in Table 1. Of the cases, 192 (43%) were among residents of long-term care facilities or long-term acute care hospitals; 340 (77%) cases were identified in patients over >50 years, and 168 (38%) cases have a death on record through January 2022. Among isolates with a carbapenemase gene (n = 129), KPC (32%) was the most commonly identified (Table 2). Conclusion The high burden of CROs in Alameda County highlights the need for continued partnership on reporting, testing and infection prevention measures to limit the spread of resistant organisms. A large proportion of cases were identified in vulnerable long-term care residents and 104 (24%) cases were identified as carbapenemase-producing, with a higher percentage among CRAB isolates, informing future targeted public health interventions. Disclosures All Authors: No reported disclosures. |
