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.

Continue reading

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.

Continue reading

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

Continue reading

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.

Continue reading

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.

Continue reading

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.

Continue reading

Dispersal of CPE from contaminated sinks and drains: a refection from Infection Prevention 2019

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.

Continue reading

Oh, the fun you can have with a urinary catheter and a drain

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.

Continue reading

21 is the magic number (for defining CPE person-to-person transmission using WGS)

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.

Continue reading