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Background Though CPE in Canada are mainly acquired abroad, outbreaks/transmission in Canadian hospitals have been reported. We determined the incidence of HA CPE in southern Ontario, Canada, to inform prevention and control programs. Methods Toronto Invasive Bacterial Diseases Network (TIBDN) has performed population-based surveillance for CPE in the Toronto area/Peel region of southern Ontario, Canada, since CPE were first identified in October 2007. Clinical microbiology laboratories report all CPE isolates to TIBDN; annual lab audits are performed. Incidence calculations used first isolates as numerator; denominator (patient-days/fiscal year for Toronto/Peel hospitals) was from the Ontario Ministry of Health and Long-Term Care. Results The incidence of HA CPE has risen from 0 in 2007/2008 to 0.45 and 0.28 per 100,000 patient-days for all and clinical cases, respectively, in 2017/2018 (Figure, P  72 hours post-admission (of which 83 also had ≥1 other prior Ontario hospitalization); 68 (36%) had their CPE identified at admission but had recent prior Ontario hospitalization. HA cases vs. foreign acquisitions were significantly more likely K. pneumoniae (48% vs. 38%, P = 0.02) and Enterobacter spp. (20% vs. 7%, P &lt; 0.0001) and less likely E. coli (20% vs. 48%, P &lt; 0.0001). Genes of HA vs. foreign acquisitions were significantly more likely blaKPC (34% vs. 12%, P &lt; 0.0001) and blaVIM (12% vs. 2%, P &lt; 0.0001) and less likely blaNDM±OXA (38% vs. 56%, P &lt; 0.0001) and blaOXA (13% vs. 27%, P = 0.0001). 36 (19%) HA cases had a negative CPE screen before their first positive CPE test (10/36 (28%) were on admission). The median incidence of HA CPE per 100,000 patient-days at each hospital was 0.44 (IQR 0.15–0.68) (P &lt; 0.0001). Conclusion A quarter of CPE cases in southern Ontario were HA and the incidence of HA cases is increasing. Most cases were admitted to &gt;1 Ontario hospital. Strategies to control transmission are critical. Disclosures All authors: No reported disclosures.

512. Healthcare-Acquired (HA) Carbapenemase-Producing Enterobacteriales (CPE) in Southern Ontario, Canada: To Whom Are We Transmitting CPE?