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.
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.
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.
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|
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.
I’ve spent the last couple of days up in Liverpool for Infection Prevention 2019. One of the highlights was a talk by Dr Paz Aranega-Bou on the issues around contamination of sinks and drains. Paz flagged a paper just published in JHI investigating the dispersal of CPE in a sink/drain test risk at PHE, showing the CPE can make its way from contaminated drains to sink and surrounding surfaces via splashback.
We have blogged a fair bit recently about the risk of antibiotic-resistant Gram-negative bacterial contamination of sinks and drains. A new study offers a novel approach to this problem: by repurposing a balloon catheter to extend the duration of contact between a disinfectant and the sink-end of the pipe.
A fascinating study from a European research group has unravelled the molecular epidemiology of a large European collection of carbapenem-resistant Klebsiella pneumoniae clinical isolates. Most carbapenem resistance was due to an acquired carbapenemases, transmission clusters were common within and between hospitals, carbapenemase-producing isolates are more likely to spread in hospitals, and 21 SNPs is the magic number for defining CPE person-to-person transmission using WGS.