Community-associated Carbapenem-Resistant Organism Case Investigations in New York City
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Background
Community-associated carbapenem-resistant organisms (CA-CRO) are a growing concern. The New York City (NYC) Health Department sought to identify, quantify, and characterize CA-CRO in NYC.
Methods
CA-CRO cases were gram-negative carbapenem-resistant bacteria, cultured from urine or skin, collected December 2020–May 2023 among NYC residents aged ≤70 years with no international travel, hospitalizations, or long-term care facility stays within 12 months before specimen collection. Data were from laboratory-based surveillance, medical records, and patient interviews asking about medical and behavioral history. Sequencing was conducted to explore potential genomic clustering.
Results
Among 114 patients eligible after chart review, 75 were reached for screening. Of those, 36 met the case definition and were interviewed: 61% were female; 39% Latino, and 19% Black; median age was 61 years; and 36% lived in high/very high poverty areas. Fifty-eight percent reported ≥1 comorbidity; 35% reported taking antibiotics within 3 months of specimen collection; and 25% had a urinary catheter or indwelling device within 2 days of specimen collection. Only 6 of 15 sequenced isolates clustered with other sequences from public repositories or laboratory databases.
Conclusions
CA-CRO were rare. Patients with a CA-CRO were disproportionately female, non-white, and medically complex. Interviews enhanced eligibility screening and facilitated gathering rich medical and behavioral histories. Despite limited sequencing, the preponderance of non-clustering isolates suggested that coverage of CRO sequences for comparison was limited. The NYC Health Department continues to monitor this public health threat, and clarify factors associated with CRO acquisition, ultimately to help control CRO spread into the community.
