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Background Historically, carbapenem-resistance in P. aeruginosa (PA) has been mediated by inducible AmpC, drug efflux, and porin loss; however, carbapenemase production is an increasingly recognized entity. Of these mechanisms, carbapenemases can drastically reduce treatment options and rapidly disseminate. Since broad applications of phenotypic (mCIM/eCIM) and PCR-based detection can be labor intensive and costly, we developed an MIC derived algorithm to streamline use of these definitive carbapenemase detection methodologies. Methods To develop the testing criteria, a challenge set of PA (n=92), NDM, IMP, VIM, KPC, SPM, GES, cephalosporinase or efflux/porin mutation and wild-type isolates were utilized. Broth microdilution MICs were determined for: ceftazidime (CAZ), cefepime (FEP), piperacillin/tazobactam (TZP), meropenem (MEM), imipenem (IPM), ceftolozane/tazobactam (C/T), and ceftazidime/avibactam (CZA). To assess the utility of CAZ, FEP, TZP, and C/T screening criteria from the challenge set, 1,209 clinical PA isolates from a US surveillance program were tested. Confirmatory genotypic and phenotypic testing for evidence of carbapenemases was conducted on all criteria-derived isolates using the Xpert Carba-R assay and the modified carbapenem inactivation method (mCIM)/EDTA-modified carbapenem inactivation method (eCIM), respectively. Results Test performance and characteristics of the challenge set are displayed in Table 1. Of the 1,209 clinical isolates, 230 (19%) were IPM and MEM resistant. 116 isolates met the defined criteria (using most common anti-pseudomonal β-lactams) of: IPM and MEM resistance; non-susceptibility to CAZ, FEP, and TZP. Carba-R identified 5 carbapenemase-producing isolates (all blaVIM-positive), while the mCIM/eCIM detected 7 carbapenemase-producing isolates (including the 5 blaVIM-positive isolates). Table 1. Characteristics of the Challenge Set of 92 P. aeruginosa isolates utilized in algorithm development. Conclusion In the presence of carbapenem resistance, non-susceptibility to FEP, CAZ, and TZP (or C/T when available) is a useful starting point to delineate CP-PA versus non-CP-PA. This MIC criterion combined with either mCIM/eCIM or PCR-based testing is a pragmatic and streamlined approach to identify CP-PA, while providing vital information to guide therapeutic and infection control measures. Disclosures David P. Nicolau, PharmD, Cepheid (Other Financial or Material Support, Consultant, speaker bureau member or has received research support.)Merck &amp; Co., Inc. (Consultant, Grant/Research Support, Speaker’s Bureau)Wockhardt (Grant/Research Support)

656. Development and Application of a Pragmatic Algorithm for the Detection of Carbapenemase-Producing Pseudomonas aeruginosa (CP-PA)