Community-associated Carbapenem-Resistant Organism Case Investigations in New York City

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.

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.

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.

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. Competing Interest Statement The authors have declared no competing interest. Funding Statement At the New York City Health Department and Public Health Laboratory, this surveillance-based work was supported by funding from the Centers for Disease Control and Prevention (CDC) Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases Cooperative Agreements (ELC). At Wadsworth Center, this work was supported by the New York State Department of Health, Cooperative Agreement, Number NU50CK000423 funded by the CDC, and Cooperative Agreement U60OE000103 funded by CDC through the Association of Public Health Laboratories. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: These activities were considered public health surveillance and deemed exempt from review by the NYC Health Department Institutional Review Board. See Supplemental Materials for additional details on methods. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data from this manuscript is not available.