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.
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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.
CPE contamination of hospital wastewater: smoking gun or innocent bystander?
A recent US study has investigated CPE contamination of sinks, drains, and wastewater. Carbapenemase-producing bacteria were identified throughout the drainage and water system, from drains in patient rooms, right through to wastewater sampled through manholes adjacent to the hospital. My main question in all of this is whether this huge reservoir of carbapenemases in hospital wastewater is a risk for patients. The lack of genetic similarity between isolates in hospital wastewater and isolates from patients suggest not, but I suspect there’s an indirect link and these carbapenemases find their way into isolates affecting humans, which is supported by genetic links between the plasmids carrying the carbapenemases.
Reflections on Infection Prevention and Control 