ISR 84 - Management of a Multi-facility Outbreak of Carbapenem-resistant Enterobacterales (CRE) Producing New Delhi Metallo-beta-lactamase (NDM) in North Texas

Background: During the ongoing Candida auris outbreak in North Texas, healthcare facilities have been on alert for the transmission of different multidrug-resistant organisms (MDROs) within the facilities. The emergence of Carbapenem-resistant Enterobacterales (CRE) producing New Delhi metallo-beta-lactamase (NDM) is rare and has raised significant public health concerns. A detailed epidemiological approach is needed when healthcare facilities experience a CRE-NDM outbreak.

Methods: In May 2022, an acute care hospital (ACH) reported a CRE-NDM case to the local health department (LHD). Discussion was held between the LHD and state partners on the Centers for Disease Control and Prevention (CDC) tiered CRE-NDM approach. Telephonic discussion occurred between the LHD, ACHs, and the state partners, followed by an in-person Infection Control Assessment Response (ICAR). An ICAR was conducted with the ACH, and infection control gaps were identified. Point Prevalence study (PPS) was not initiated with the ACH due to the method of specimen collection. Active surveillance and Transmission Based Precaution (TBP) were implemented with the facilities. CRE isolates were confirmed at the state laboratory and were sent to the Antibiotic Resistance (AR) Laboratory Network. (ARLN). The CDC Laboratory performed a whole genome sequence (WGS).

Results: The LHD received 43 CRE-NDM case reports with collection dates ranging from May 14, 2022, to September 8, 2023. Of the 43 cases, 69.04% (n=29) were female. The age range was from 18 to 91 years, with a mean age of 67 and a median age of 69. WGS was performed on 14 isolates. The isolates showed relatedness between the isolate.

Conclusions: Early identification of cases helped the LHD recommend placing close contacts on TBP. WGS results supported the epidemiology data showing relatedness between cases and indicated transmission within facilities. The LHD provided recommendations to the facilities to improve infection control practices.