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Volume 24, Number 9—September 2018
Research

Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada1

Philipp P. Kohler2Comments to Author , Roberto G. Melano, Samir N. Patel, Shumona Shafinaz, Amna Faheem, Brenda L. Coleman, Karen Green, Irene Armstrong, Huda Almohri, Sergio Borgia, Emily Borgundvaag, Jennie Johnstone, Kevin Katz, Freda Lam, Matthew P. Muller, Jeff Powis, Susan M. Poutanen, David Richardson, Anu Rebbapragada, Alicia Sarabia, Andrew Simor, Allison McGeer, and for the Toronto Invasive Bacterial Diseases Network (TIBDN)
Author affiliations: Sinai Health System, Toronto, Ontario, Canada (P.P. Kohler, S. Shafinaz, A. Faheem, B.L. Coleman, K. Green, E. Borgundvaag, S.M. Poutanen, A. McGeer); Public Health Ontario Laboratories, Toronto (R.G. Melano, S.N. Patel); University of Toronto, Toronto (R.G. Melano, S.N. Patel, B.L. Coleman, I. Armstrong, J. Johnstone, K. Katz, M.P. Muller, J. Powis, S.M. Poutanen, A. Sarabia, A. Simor, A. McGeer); Toronto Public Health, Toronto (I. Armstrong); LifeLabs, Toronto (H. Almohri); McMaster University, Hamilton, Ontario, Canada (S. Borgia); William Osler Health System, Brampton, Ontario, Canada (S. Borgia, D. Richardson); St. Joseph’s Health Centre, Toronto (J. Johnstone); Public Health Ontario, Toronto (J. Johnstone, K. Katz, F. Lam); North York General Hospital, Toronto (K. Katz); St. Michael’s Hospital, Toronto (M.P. Muller); Toronto East Health Network, Toronto (J. Powis); University Health Network, Toronto (S.M. Poutanen); Dynacare, Brampton (A. Rebbapragada); Trillium Health Partners, Toronto and Mississauga, Ontario, Canada (A. Sarabia); Sunnybrook Health Sciences Centre, Toronto (A. Simor)

Main Article

Table 1

Isolate source and infection type among patients colonized or infected with carbapenemase-producing Enterobacteriaceae, Metropolitan Toronto and the Regional Municipality of Peel, south-central Ontario, Canada, 2007–2015*

Characteristic No. (%)
All patients, n = 258 Escherichia coli, n = 86 Klebsiella pneumoniae, n = 122 Enterobacter spp., n = 30 Other,† n = 20
Isolate source‡
Only screening 115 (45) 58 (67) 47 (39) 6 (20) 4 (20)
>1 clinical
149 (58)
30 (35)
79 (65)
24 (80)
16 (80)
Positive specimen types at first identification§
Rectal or colostomy 138 (54) 61 (71) 64 (53) 9 (30) 4 (20)
Urine 89 (35) 19 (22) 52 (43) 11 (37) 7 (35)
Blood 21 (8) 4 (5) 9 (7) 3 (10) 5 (25)
Wound 15 (6) 2 (2) 10 (8) 1 (3.3) 2 (10)
Sputum or broncoalveolar lavage 12 (5) 1 (1) 6 (5) 3 (10) 2 (10)
Other
17 (7)
4 (5)
5 (4)
6 (20)
2 (10)
Infection‡
Any 92 (36) 21¶ (24) 46 (38) 13 (43) 12 (60)
Urinary tract 75 (29) 19 (22) 46 (38) 6 (20) 4 (20)
Pneumonia 13 (5) 4 (5) 3 (3) 4 (13) 2 (10)
Other# 13 (5) 3 (4) 5 (4) 3 (10) 2 (15)
Primary bacteremia** 13 (5) 2 (2) 4 (3) 2 (7) 1 (5)

*Among first patient isolates; sums of specimen types exceed the number of patients because >1 specimen type may have yielded carbapenemase-producing Enterobacteriaceae.
Citrobacter spp. (n = 7), Morganella morganii (n = 4), Serratia marcescens (n = 4), Klebsiella oxytoca (n = 3), Providencia rettgeri (n = 1), Proteus mirabilis (n = 1).
‡Including all follow-up isolates available and all infections during the patients' hospitalization.
§Including isolates from all specimens obtained within 2 days of the first positive specimen.
¶One patient originally colonized with a carbapenemase-producing E. coli subsequently experienced an infection with a carbapenemase-producing Enterobacter cloacae.
#Includes 7 skin or soft tissue infections, 5 bone or joint infections, and 1 abdominal infection.
**Patients with secondary bacteremia were classified according to their primary source of infection (urinary tract [n = 12] and pneumonia [n = 6]). Two bacteremic patients had both urinary tract infection and pneumonia diagnosed.

Main Article

1Preliminary results from this study were presented at IDWeek, October 26–30, 2016, New Orleans, Louisiana, USA.

2Current affiliation: Cantonal Hospital, St. Gallen, Switzerland.

3Additional members are listed at the end of this article.

Page created: August 15, 2018
Page updated: August 15, 2018
Page reviewed: August 15, 2018
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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