P-1367. Changing Epidemiology of Carbapenemase-producing Carbapenem-resistant <i>Enterobacterales</i> (CRE) in Taiwan

Abstract Background Rapid spread of carbapenemases (CP) among Enterobacterales require prompt identification to enable timely and appropriate treatment. This study aimed to determine the accuracy of NG-Test CARBA 5 for rapid detection of CP and to describe the epidemiology of carbapenem-resistant Enterobacterales (CRE) in Taiwan.Fig 1.Increasing Prevalence of Carbapenemase-producing Carbapenem-resistant Enterobacterales (CRE) in Taiwan (2018-2023) Methods 316 isolates of CRE were collected from a medical center, Kaohsiung Veterans General Hospital in Taiwan during 2018 to 2023, of which 30.4% were CP producers. The NG-Test CARBA5, PCR for blaKPC, blaVIM-2, blaIMP, blaNDM, and blaOXA-48-like genes were performed on 101 strains. Sequencing and phylogenetic analysis for blaKPC and blaNDM was done.Table 1.Performance of Rapid NG-Test Carba 5 compared to PCR for detecting carbapenemase genes in clinical isolates of carbapenem-resistant Enterobacterales (CRE) in Taiwan (N=101) Results A significant increase in the prevalence of CP-producing CRE was observed during this period from 9.9% before 2020 to 29.0% in 2020-2021 and 48.6% in 2022-2023 (OR for trend: 2.46, 95% CI: 1.78-3.38, p&amp;lt; 0.001). CP genes was detected by PCR in 100%, however, the NG-Test CARBA 5 failed in 9 strains, with a detection rate of 91.1%. The agreement between the 2 methods were high (94.4 % for CR-Escherichia coli, 90.6 % for CR-Klebsiella pneumoniae, 87.5 % for CR-Citrobacter freundii and 81.8 % for CR-Enterobacter spp). The major CP genes in CRE was blaKPC 38.6%, blaNDM 34.7%, blaIMP7.6% and blaOXA-48-like 6%. Metallo-β-lactamase (MBL) genes became prevalent over time and accounted for 54.5% of CP genes, which was mainly found in CR-E.coli. Highest expression of CP genes blaKPC and blaOXA-48 was in CR-K.pneumoniae (52.9% and 27.5%, blaNDM was in CR-E.coli (55.6%), and blaIMP in CR-Enterobacter spp. (68.2%). The most common genotype of blaNDM was blaNDM-1 (24/35, 68.6%), following by blaNDM-5 (9/35, 25.7%) and blaNDM-4 (2/35, 5.7%). All 33 blaKPC strains were KPC-2 type.Fig 2.Distribution of Carbapenemase (CP) genes in clinical isolates of CP-producing CRE in Taiwan (N=101) Conclusion Our study demonstrated that the NG-Test CARBA 5 was useful for rapid detection of CP genes, and the rising prevalence of MBL genes in Taiwan is a cause of concern due to limited treatment options. Disclosures All Authors: No reported disclosures