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 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, regardless of infection or symptom status. Data were from laboratory-based surveillance, medical records, and patient interviews. 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 5 of 15 sequenced isolates clustered with sequences in the National Center for Biotechnology Information. Conclusions: CA-CRO was 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.