Who’s looking for CPE in English hospitals?

A team of authors surveyed NHS acute hospitals in England to determine the approach to CPE detection, including laboratory methods. The findings provide an opportunity to compare the approach to CPE detection and prevalence nationally, identifying higher CPE prevalence in the North-West, North-East and the South-East (the region that includes London) of England. The findings also suggest that more screening for CPE would detect more carriers – and perhaps help to prevent a silent epidemic of CPE in some regions.

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Can we ever de-isolate CPE carriers?

One of the questions that we often ask ourselves is whether carriers of CPE (and other MDR-GNR) can de-isolated. Most of the guidelines are pretty non-committal on this point due to lack of evidence. Some new guidelines from ESCMID-EUCIC address this issue head on. But, unfortunately, the answer is that de-isolation of CPE carriers, particularly over the course of a single hospitalisation, isn’t going to work because there’s no effective decolonisation method.

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Rampant carbapenem-resistant Klebsiella BSIs: a window to a post-antibiotic apocalypse?

People have been talking in apocalyptic terms for years – probably decades – about the threat of AMR. But has this really materialised? MRSA BSIs are now rare in the UK, and C. difficile infections are rarer than they once were. But things are looking considerably gloomier in other parts of the world. For example, a frankly shocking study from a Greek ICU gives us a view of what a post-antibiotic apocalypse may look like…

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Can we de-isolate carriers of CPE?

Although there’s some controversy about whether or not we should apply contact precautions (by that I mean single room isolation, enhanced PPE, enhanced disinfection etc) all the time for all organisms, it would be a brave hospital to eschew contact precautions for CPE carriers. And so the question of whether and when we should ‘de-isolate’ patients with known CPE is an FAQ. And so enter a recent study in CMI comparing the spontaneous apparent loss of colonisation with various CPEs, concluding that KPC carbapenemases seem to hang around for longer than NDM carbapenemases, but both almost always last for the duration of a single hospitalisation.

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The best IPC article of 2018: a blogoff with Brett Mitchell

In honour of Infection Prevention 2018, Brett Mitchell and I are having a blogoff so that you can choose the best IPC article of 2018. This post presents my case, Brett’s post (here) presents his case, and there’s a vote below so that you can choose. The results will be published next Monday morning at Infection Prevention 2018…

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Evaluating the economic value of the CDC CRE Toolkit

Continuing the theme of CPE (or CRE if you prefer) Toolkit evaluation, a US research group has performed a modelling study to evaluate the economic impact of the US CDC CRE Toolkit. Curiously, whilst all approaches generated cost savings eventually, hospitals acting independently rather than as a co-ordinated region resulted in faster but ultimately smaller cost savings.

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