CPE screening Q&A: the who, when, and how

I gave a talk yesterday as part of a PHE London event on the whys and wherefores of screening for MDROs – my talk was focussed on CPE, and you can download my slides here: “CPE: seek and ye shall find”. I thought a quick Q&A would be the best way to summarise the content.

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Staff screening for MDROs: closing Pandora’s Box

A brave study from the Palmore/Frank group at NIH has opened the Pandora’s Box that is screening staff for MDROs, and, I’m delighted to say, firmly closed it with their findings! Only 3% of staff carried ESBLs, one carried a CPE, and none carried VRE, and this despite extensive contact with MDRO patients for many of the staff sampled!

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Everybody needs good neighbours (for sharing CPE)

BMC Medicine have recently published a study from researchers in Oxford, PHE, and Manchester illuminating the importance of referral networks in the transmission of CPE. The bottom line is that regional referral networks seem to be the most important driver of CPE spread, such that a small CPE problem close to home is more of a threat than a larger CPE problem in a distant referral network!

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What do you do to prevent VRE transmission?

What do you do to prevent VRE transmission?

…you are not alone, if the answer to this question is ‘nothing special’, based on survey published in ARIC! Dale Fisher’s team in Singapore put together a simple survey, asking the global IPC community what measures they have in place to prevent the transmission of VRE. There was a huge degree of variability, ranging from ‘nothing special’ to ‘the kitchen sink’!

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CPE carriage: a rare event in London?

My old CIDR team have just published a study in JAC reporting a very low rate of carriage of CPE in patient admitted to a hospital in central London (just 5 (0.1%) of 4006 patients). This was a lot lower than we expected! Despite the very low rate of carriage, overseas hospitalisation was a significant risk factor for CPE carriage, and supports that we should be screening patients with recent overseas hospitalisation for CPE carriage.

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Reducing Gram-negative BSI…by accident

E_choli_Gram

We have precious little data on what works to prevent the transmission of MDR-GNR. An interesting article published recently in CID provides invaluable data that an infection control programme aimed at reducing MRSA (and succeeding) was also effective in reducing GNR BSI!

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Balancing risk and resource for CPE screening

Klebsiella_pneumoniae_01

The PHE Toolkit recommends pre-emptive isolation for patients who meet one of the risk-factor triggers for CPE screening. Furthermore, the pre-emptive isolation recommended in the Toolkit should be continued until three negative screens are obtained, each separated by 48 hours. In what is best described as a data-based thought experiment, colleagues from Imperial tested the impact of various CPE screening strategies on the burden of contact precautions generated.

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Urine – not to be sniffed at – or is it?

crotchjpgDogs are recognised to have the keenest of noses and have been used for detecting illicit drugs, early stage cancer and even C. difficile including an outbreak (possibly a cheaper option than PCR for screening – I should have used this in my debate with Jon). Now a new study finds that trained dogs can reliably detect significant bacteriuria.

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Should we start admission screening for C. difficile carriage? A Kiernan vs. Otter pro-con debate!

debate

Both Martin and Jon wanted to post a blog about the same article, so thought we’d put our hands together, so to speak, into a pro-con format! We hope you find it useful.

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