P-157. Molecular epidemiology of carbapenemase genes among carbapenem-resistant <i>Klebsiella pneumoniae</i> (CR-<i>Kp</i>) from the Philippines: implications for surveillance and treatment

Abstract Background In the Philippines, the proportion of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has doubled in the past decade and now exceeds 15%. However, the prevalence of different carbapenemase genes remains unknown. Unlike the United States and China where blaKPC predominates, blaOXA-48-like serine carbapenemases and metallo-β-lactamases (MBL) blaNDM, -IMP, and -VIM frequently occur among CR-Kp in the Asia-Pacific region. In order to better inform empiric treatment strategies and assist with infection prevention, we investigated the carbapenemases present in CR-Kp from the Philippine General Hospital (PGH), a 1,500-bed tertiary care national referral center in Manila, Philippines.Table 1.Carbapenemase genes detected with Xpert® Carba-R among carbapenem-resistant Klebsiella pneumoniae isolates from the Philippine General Hospital in Manila, Philippines. Methods CR-Kp from clinical samples were identified in the clinical microbiology laboratory at PGH using the VITEK® 2 platform (bioMerieux, USA). These isolates were collected and underwent rapid molecular testing with Xpert® Carba-R (Cepheid, USA) at the central laboratory of the Philippine National Institutes of Health. Molecular test results were typically available within 24 hours from the time of identification. These results were relayed to the treating physicians to guide clinical decision-making. Results A total of 81 CR-Kp isolates were collected from February to May 2024. Isolates were obtained from respiratory (n=44, 54.3%), blood (n=24, 29.6%), urine (n=9, 11.1%), and tissue/wound (n=4, 4.9%) samples. Table 1 summarizes the carbapenemase genes detected with Xpert® Carba-R among CR-Kp isolates from PGH, including multiple genes present in some samples. Conclusion Among CR-Kp from PGH, blaNDM was the predominant carbapenemase, followed by blaOXA-48-like and blaKPC genes. A third of the isolates co-harbored blaNDM and a serine carbapenemase, usually blaOXA-48-like. These findings suggest that there is molecular heterogeneity and likely plasmid spread among CR-Kp in the Philippines. These findings also underscore the importance of molecular surveillance programs that can rapidly characterize resistant strains, highlight the emergence of novel genotypes, and inform empiric and definitive therapy for CR-Kp. Disclosures Federico Perez, MD, MS, Merck: Grant/Research Support David Paterson, Infectious Diseases Physician, AMR Action Fund: Board Member|Aurobac: Advisor/Consultant|bioMerieux: Grant/Research Support|bioMerieux: Honoraria|CARB-X: Advisor/Consultant|Entasis: Expert Testimony|Menarini: Honoraria|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support|Shionogi: Honoraria