CRE: coming to a hospital near you

carbapenemase

I thought for quite some time about whether the title to this post ought to be a statement or a question. I decided on a statement: pretty much wherever you are in the world, I am certain that CRE is now one (hospital) degree of separation from you.

I gave this talk yesterday at the imaginatively named “Darling Bugs of May” IPS conference, and you can download my slides here. I’ve given similar talks before, but the whole thing took on greater significance now I have had some first hand experience of making decisions around the management of CRE patients.

Key points to put across are:

  • General state of awareness about CRE. Around 10% of the audience had not even heard of it.
  • Nomenclature. Do we go for CRO, CRE or CPE? My (albeit evolving) view is that CRE should describe the general picture, and CPE specific cases that are known carbapenemase producers. However, education is needed here, because only one solitary member of the 200-strong audience felt confident enough to explain the difference between CRE and CPE!
  • What should our screening strategy look like? Ask 15 microbiologists around the country (and I have), and you will get 15 different answers. My current thinking is that a simple risk factor question of whether the patient has had a hospital stay anywhere in the past 12 months probably covers most bases and is relatively straightforward to implement. But how to address overseas travel or residence without healthcare contact? Answers on a postcard please.
  • What should we be doing to prevent transmission? Evidence is limited, so in the smart money is on a “kitchen sink” approach!

Above all else, we need to find creative ways of getting across to our non-specialist colleagues and the public that this isn’t “the new MRSA” – it’s a lot more challenging than that!

Image: ‘OXA-48 like carbapenemase.’

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4 thoughts on “CRE: coming to a hospital near you

  1. Yes, plenty of imponderables with this one. The screening is key, risk assessment for all admissions but how to get staff to do it? That is why most hospitals in England continue with MRSA screening for all, despite evidence that this is costly and unecessary. Overseas travel is also interesting although it seems that it is only recent travel and organisms smuggled into the country in the colons of returning travellers are pretty transient, so maybe a 3-month cutoff?

    We also need to come to a consensus on nomenclature so that we can get the key messages over. Telling an audience of non-specialisis that we cannot decide on what to call these organisms isn’t going to help in getting the message over. We need to simplify and make sure that everyone sings from the same hymnsheet. It’s all a bit Shostakovich at the moment for my liking

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  2. Very interesting Jon, I do wonder why we refer to contact precautions with the CDC definition of ‘gloves and gown’ when in the UK ‘gowns’ are actually very rarely used, most hospitals use the small white plastic aprons providing protection for the front of the uniform only. should we be using ‘gowns’?

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