An outbreak of Carbapenemase-producing Enterobactericeae in a neonatal intensive care unit, NSW, Australia

Munnoch, Sally; Deane, Jeffrey; Varadhan, Hemalatha; Givney, Rodney; Iredell, Jon; Zakour, Nouri L. Ben; McIntosh, Joanne; Ferguson, John

doi:10.1016/j.idh.2018.09.061

Cited by 3 publications

(2 citation statements)

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“…While the importation of CPE, particularly from South and Central Asia, and the predominance of IMP carbapenemase in local transmissions within Australia were anticipated [ 9 , 10 , 12 , 13 , 26 ], our results differed from those previously reported, in several ways. First, intensive case investigation identified travel to South and South-East Asia without healthcare contact as an emerging risk factor for NDM-producing E. coli ; IMP transmission, thought to be endemic in Australia’s eastern states [ 26 ], and initially debated for inclusion in the program, affected only a small number of facilities; and intensive infection-control actions have resulted in a higher proportion of CPE cases identified through screening, and a lower occurrence of serious infections, than reported elsewhere [ 24 ].…”

Section: Discussioncontrasting

confidence: 99%

Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-producing Enterobacterales

Lane

Brett

Schultz

et al. 2020

Clinical Infectious Diseases

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Background Multi-resistant organisms (MROs) pose a critical threat to public health. Population-based programs for control of MROs such as Carbapenemase-producing Enterobacterales (CPE) have emerged and evaluation is needed. We assess the feasibility and impact of a state-wide CPE surveillance and response program deployed in December 2015 across Victoria, Australia (population 6.5 million). Methods A prospective multi-modal intervention including active screening, carrier isolation, centralised case investigation and comparative pathogen genomics was implemented. We analyze trend in CPE incidence and clinical presentation, risk factors and local transmission over the program’s first three years (January 2016 to December 2018). Results CPE case ascertainment increased over the study period to 1.42 cases/100,000 population, linked to increased screening without a concomitant rise in active clinical infections (0.45-0.60 infections/100,000 population, p=0.640). KPC-2 infection decreased from 0.29 infections/100,000 population prior to intervention to 0.03 infections/100,000 population in 2018 (p=0.003). Comprehensive case investigation identified putative overseas community acquisition. Median time between isolate referral and initial genomic and epidemiological assessment for local transmission was 11 days (IQR 9-14). Prospective surveillance identified numerous small transmission networks (median 2, range 1-19 cases), predominantly IMP and KPC, with median pairwise distance of 8 (IQR 4-13) single nucleotide polymorphisms; low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted response. Conclusions We demonstrate the value of centralised CPE control programs to increase case ascertainment, resolve risk factors and identify putative local transmission through prospective genomic and epidemiological surveillance; methodologies are transferable to low-prevalence settings and MROs globally.

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Section: Discussioncontrasting

confidence: 99%

Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-producing Enterobacterales

Lane

Brett

Schultz

et al. 2020

Clinical Infectious Diseases

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“…In Australia, CPE have rarely been identified and are usually associated with patients receiving overseas medical care in endemic countries, except for IMP-4 which has established low-level endemicity in some states (9,10). Limited outbreaks of CPE within healthcare facilities have also been described (10)(11)(12)(13). Between 2012 and 2014 an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales occurred in Victoria (population 6.5 million) affecting multiple healthcare settings and facilities (14).…”

Section: Introductionmentioning

confidence: 99%

Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-Producing <i>Enterobacterales</i>

et al. 2020

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Epidemiology of early- and late-onset serious bacterial infections in Australian neonates and infants: A retrospective multicentre study

Williams,

Mostaghim,

Harrison

et al. 2024

Preprint

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BackgroundThere has been little decline in neonatal mortality rates over recent decades, and this is now further challenged by the rising prevalence of antimicrobial resistance (AMR). In Australia, the incidence of neonatal sepsis is low on a global scale, yet there are increasingly frequent outbreaks of multidrug-resistant (MDR) infections in neonatal intensive care units, alongside rising rates of colonisation with MDR bacteria.MethodsWe analysed positive blood and cerebrospinal fluid (CSF) cultures collected from infants (aged 0 to ≤180 days) across five clinical sites in Australia between 2010 and 2019, to determine evolving antimicrobial susceptibility profiles.ResultsAfter excluding presumed contaminants, we analysed 743 pathogenic bacterial isolates cultured from 624 neonates and infants with early- (≤72 hours), late- (>72 hours to ≤28 days), and very late-onset (>28 days to ≤180 days) infections.Escherichia coli(37%) andStreptococcus agalactiae(31%) were the primary pathogens responsible for early-onset bloodstream infections, whilst coagulase-negative staphylococci,E. coliandStaphylococcus aureuswere responsible for most infections in older neonates and infants. Antimicrobial susceptibility to currently-recommended empiric regimens remains high; however, gram-negative bacteria – including MDR bacteria – were responsible for an increasing proportion of very late-onset infections over the study period (22% in 2010-2014 versus 34% in 2015-2019; p=0.07).ConclusionsAlthough empiric antimicrobial regimens remain adequate for most pathogens causing infections in neonates and infants in Australia, there is an increasing burden of invasive infections caused by gram-negative bacteria. Ongoing surveillance is necessary to ensure empiric antimicrobial guidelines remain efficacious and appropriate.

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An outbreak of Carbapenemase-producing Enterobactericeae in a neonatal intensive care unit, NSW, Australia

Cited by 3 publications

References 0 publications

Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-producing Enterobacterales

Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-producing Enterobacterales

Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-Producing <i>Enterobacterales</i>

Epidemiology of early- and late-onset serious bacterial infections in Australian neonates and infants: A retrospective multicentre study

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