A systematic review and meta-analysis identify 22 studies that used various methods to predict colonisation with antibiotic-resistant bacteria at the time of hospital admission. The models were chosen to focus on MRSA and CPO colonisation. The “performance” of these tools varied widely, with a sensitivity of 15–100% and specificity of 46–98.6% for MRSA, and sensitivity of 30–81.3% and specificity of 79.8–99.9% for CPO. I think my main take-away from this that simple risk tools for predicting colonisation with MRSA and CPO (which are often used to determine who to test) are pretty blunt instruments. However, the more advanced tools making use of big datasets and machine learning can take us forward in predicting the risk of MRSA and CPO colonisation at the time of admission.
Continue readingCPE
Establishing the transmission rate of CPE in hospitalised patients
A helpful new study has combined shoe-leather epi and WGS to establish a transmission rate of CPE in hospitalised patients. Overall, 3 (2%) of 152 exposed patients ended up colonised with the same CPE from 47 index patient exposures. None of the 54 exposed staff ended up colonised with CPE. This transmission rate is a bit lower than I would have expected, but it’s also not zero!
Continue readingHCAI and AMR point prevalence from Ukraine
JHI have just published an interesting point prevalence HCAI and AMR study from Ukraine. Headlines are that rates of both HCAI and AMR are higher than you’d hope to see, especially with rates of resistant to carbapenems in Gram-negative bacteria and meticillin in S. aureus.
Continue readingCPE: seek and ye shall find
We recently published a study in the Journal of Antimicrobial Chemotherapy relating the impact of introducing an enhanced testing* programme for CPE in London. (And yes, this is the first post for a while that isn’t on COVID-19!) Following an outbreak of NDM-producing Klebsiella pneumoniae affecting 40 patients in 2015 (published elsewhere, here and here), we ramped up our CPE testing programme. The number of patients carrying CPE increased substantially, from around 10 patients per month in June 2015 to around 50 per month in March 2018. However, the proportion of tests that were positive for CPE remained constant at around 0.4%, suggesting this was more effective carrier identification rather than a swelling pool of carriers per se; seek and ye shall find! Curiously, the majority of CPE identified were not linked in time and space with other CPE, suggested they represented a ground-swell of CPE coming into the hospital, rather than frequent in-hospital transmission. Also, the number of patients with CPE infections during the study period did not increase, which was reassuring.
Can you GES which carbapenemase caused this CPE outbreak?
An unusual and interesting outbreak of CPE was published recently in Clinical Infectious Diseases. Several key points: don’t rely solely on a PCR detecting the “Big 5” carbapenemases (NDM, KPC, OXA-48, IMP, VIM) – at some point you need to test for phenotypic carbapenemase activity; WGS can really help us in unravelling complex transmission routes; and covert plasmid propagation within and between species is a reality.
CPE has landed in East London
The team at Barts Health, one of the largest NHS hospital groups in the country, has published the findings of a point prevalence screen of all inpatients for carbapenemase-producing organism (CPO) carriage. Overall, 30 (3.1%) of the 977 patient tested were carrying 35 different CPOs (all but one of which were CPE). Risk factors for CPO carriage included hospitalisation abroad, any hospitalisation, and overseas travel (especially to India, Pakistan, and Bangladesh). These findings help us to understand an emerging picture of CPO in the UK.
The most visited Reflections posts of 2019
As 2019 draws to a close, I thought it would be fun to share the most visited posts of 2019 on Reflections. And here they are:
| Blog post | % views of top 10 posts | Year published |
| Do you know your CRO from your CPO from your CRE from your CPE? | 11.4 | 2013 |
| Focusing on the role of nurses in environmental hygiene | 11.3 | 2018 |
| Hand hygiene and the courage to challenge: a personal reflection | 11.1 | 2019 |
| Bad things happen when you don’t do hand hygiene | 10.7 | 2019 |
| We need to win hearts and minds to improve hand hygiene practice | 10.7 | 2019 |
| Dispersal of CPE from contaminated sinks and drains: a refection from Infection Prevention 2019 | 9.6 | 2019 |
| CRE can survive on dry surfaces for longer than you may expect | 9.3 | 2014 |
| CPE infection prevention and control guidelines: an update | 8.8 | 2019 |
| An endless one-sided confidence in Pip-tazo? | 8.6 | 2018 |
| Studying bacteriophages: catch-22 | 8.5 | 2019 |
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.
CPE carriage – once positive, always positive…or maybe not?
I blogged recently about the new ESCMID guidelines on resistant Gram-negative carriage and decolonisation, which supported a “once positive, always positive” approach to CPE carriers due to the lack of effective decolonisation options. A new study suggests that a large majority (75%) of patients who were once identified as CPE carriers no longer had CPE detectable when they were readmitted. This has implications for the management of CPE carriers in hospitals.
Infection prevention and control practices for CPE in Ontario, Canada – are we doing enough?
We’re delighted to have this guest post from Dr Alainna Jamal (bio below)…
Hello from Canada! In this blog post, I’ll reflect on findings from a study by our group (the Toronto Invasive Bacterial Diseases Network), published in this month’s issue of Infect Control Hosp Epidemiol.
Reflections on Infection Prevention and Control 