Volume 24, Number 9—September 2018
Research
Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada1
, 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)
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.
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.