CPE infection prevention and control guidelines: an update

Since writing this 2015 review on gaps and controversies in the guidelines for the prevention and control of CPE (and other MDR-GNR) I’ve tried to keep it fairly up to date. So, here’s the latest iteration, including the 2015 CDC guidelines.

The original focus of the review was European guidelines for MDR-GNR, but for this version I’ve focussed on CPE, and included the key international guidelines that I could find, especially the CDC CRE Toolkit (updated in 2015). Here’s the overview:

Table: Comparison of the recommendations in guidelines for the prevention and control of CPE. Green square = recommended; Red square = not recommended; Blank = not mentioned or no recommendation. *ESCMID guidelines did not include CPE specifically, but did include recommendation for MDR K. pneumonia, which are included here as a proxy for CPE because the guidelines also included separate recommendations for ESBL-E.

Some comments on the 2015 CDC guidelines:

  • The guidelines are framed as “CRE” guidelines, but very sensibly use my favoured terminology: CP-CRE for carbapenemase producing Enterobacterales, CRE for carbapenem-resistant Enterobacterales that may or may not be a carbapenemase producer, and non-CPE-CRE for CRE that do not produce a (know) carbapenemase.
  • A helpful phenotypic defining of CRE is included (although ask 10 microbiologists to come up with one, and you’ll get at least 12)!
  • There’s a helpful section on inter-facility notification of CPE carriage, and the general promotion of a regional approach to CPE control, which makes complete sense.
  • The guidelines don’t mention staff screening at all – in fact, none of the guidelines outside of the UK/Ireland make a recommendation either way on staff screening – almost as if the world outside of the UK/Ireland is saying “staff screening – you must be mad”!
  • I like the simple summary of recommendations on one page (p.17).
  • I also like the flowchart for detecting CPE carriers (p.18).
  • Overall, I really like the guidelines: they’re short, simple, and punchy. They don’t try to be evidence-graded guidelines (there’s only a handful of references). And they don’t fall into the trap of being too prescriptive. Instead, they are unashamedly a pragmatic set of recommendations to help healthcare facilities develop a local approach to CPE prevention and control.

I’m conscious that there are many national guidelines for CPE that are not covered here (e.g. see here) – but I hope this summary gives an overview of the areas of agreement and disagreement. I’ll try to keep it up-to-date as new / updated guidelines come out.

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