Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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 2

Characteristics of patients with carbapenemase-producing Enterobacteriaceae infections, by type of carbapenemase, Metropolitan Toronto and the Regional Municipality of Peel, south-central Ontario, Canada, 2007–2015*

Patient characteristics and risk profile All patients, n = 258† NDM, n = 145 KPC, n = 64 OXA-48, n = 32 VIM, n = 12 p value‡
Sex
M 168 (65) 94 (65) 37 (58) 25 (78) 8 (67) 0.32
F
 90 (35)
 51 (35)
 27 (42)
 7 (22)
 4 (33)
Age, y, median (IQR‡)
 70 (57–79)
 70 (59–79)
 70 (50–79)
 70 (52–77)
 77 (65–88)
 0.37
Charlson index score >2§
 88 (34)
 47 (32)
 25 (39)
 7 (22)
 7 (58)
 0.15
Inpatient at time of diagnosis 233 (90) 129 (89) 58 (91) 29 (91) 12 (100) 0.85
Days from admission to diagnosis, median (IQR)¶
 2.5 (0–21)
 0 (0–11)
 14 (0–41)
 0 (0–11)
 19 (5–67)
 0.03
CPE acquisition according to SHEA definitions#
Hospital acquired, hospital onset 113 (44) 55 (38) 35 (55) 12 (38) 8 (67) 0.10
Hospital acquired, community onset 70 (27) 41 (28) 21 (33) 4 (13) 3 (25) 0.24
Undetermined 58 (23) 40 (28) 7 (11) 11 (34) 0 0.024
Community acquired
 17 (7)
 9 (6)
 1 (2)
 5 (16)
 1 (8)
 0.12
Residing in long-term care facility
 9 (4)
 2 (2)
 4 (7)
 0
 3 (25)
 0.018
Healthcare abroad or high-risk travel**
 142/238 (60)
 98/135 (73)
 22/59 (37)
 19/27 (70)
 3/12 (25)
 0.0012
Exposures and medical interventions††
Intensive care stay 78 (30) 39 (27) 26 (41) 6 (19) 5 (42) 0.13
Mechanical ventilation 52 (20) 24 (17) 20 (31) 3 (9) 3 (25) 0.11
Previous surgery 91 (35) 29 (20) 41 (64) 13 (41) 4 (33) 0.0012
Central venous catheter
 86 (33)
 41 (28)
 32 (50)
 9 (28)
 2 (17)
 0.03
Antibiotic exposure, any 173 (67) 92 (64) 51 (80) 16 (50) 10 (83) 0.03
3rd- and 4th-generation cephalosporins 74 (29) 40 (28) 18 (28) 7 (22) 7 (58) 0.16
Carbapenems 33 (13) 14 (10) 12 (19) 3 (9) 3 (25) 0.17
Quinolones 81 (31) 41 (28) 26 (41) 6 (19) 7 (58) 0.05

*Values are no. (%) except as indicated. All characteristics and risk profile descriptors apply to the 1-year period preceding CPE detection. CPE, carbapenemase-producing Enterobacteriaceae; IQR, interquartile range; KPC, Klebsiella pneumoniae carbapenemase; NDM, New Delhi metallo-β-lactamase; OXA-48, oxacillinase 48; SHEA, Society for Healthcare Epidemiology of America; VIM, Verona integron-encoded metallo-β-lactamase.
†Three patients with Serratia marcescens enzyme and 2 with non–metallo-carbapenemase are not listed separately.
‡p values corrected for multiple testing with the Hochberg and Benjamini procedure. Bold type indicates statistical significance (p<0.05).
§No significant differences observed for any comorbid conditions.
¶Only patients included where first isolate is a clinical sample (n = 126).
#Defined as hospital acquired if hospital admission occurred within 90 days before CPE detection.
**High-risk countries and the Indian subcontinent. Denominators indicate no. patients with travel information available.
††Not listed because of nonsignificance: bronchoscopy, cystoscopy, dialysis, Foley catheter, urostomy, colostomy, tracheostomy, blood transfusion, proton-pump inhibitors, steroids, chemotherapy, immunosuppression, previously identified antibiotic-resistant pathogens (e.g., methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase).

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.
file_external