Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures

Trépanier, Pascale; Mallard, Kim; Meunier, Danièle; Pike, Rachel; Brown, D. J. F.; Ashby, J. P.; Donaldson, Hugo; Awad-El-Kariem, Fatih M.; Balakrishnan, Indran; Cubbon, Marc; Chadwick, Paul; Doughton, M.; Doughton, Rachael; Hardiman, Fiona; Harvey, G.; Horner, Carolyne; Lee, John; Lewis, J. A.; Loughrey, Anne; Manuel, Rohini; Parsons, Helena; Perry, John D.; Vanstone, Gemma L.; White, Gregory; Shetty, Nandini; Coia, John; Wiuff, Camilla; Hopkins, Katie L.; Woodford, Neil

doi:10.1093/jac/dkw414

Cited by 44 publications

(30 citation statements)

References 21 publications

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“…It is possible that there were CRE strains with carbapenemase genes that clinical laboratories did not detect by the molecular methods they had in use. However, based on the previous studies in Finland and other European countries, other carbapenemase genes than those recommended for testing in the national guideline are rare [9,18]. It is also possible that there were Enterobacterales strains with carbapenemase genes which had MICs or inhibition zones for carbapenem antibiotic below screening breakpoints.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012–2018

Räisänen

Lyytikäinen

Kauranen

et al. 2020

Eur J Clin Microbiol Infect Dis

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Carbapenemase-producing Enterobacterales (CPE) pose an increasing threat to patient safety and healthcare systems globally. We present molecular epidemiology of CPE in Finland during 2012-2018 with detailed characteristics of CPE strains causing clusters during the same time period. All Finnish clinical microbiology laboratories send Enterobacterales isolates with reduced susceptibility to carbapenems or isolates producing carbapenemase to the reference laboratory for further characterization by whole genome sequencing (WGS). In total, 231 CPE strains from 202 patients were identified during 2012-2018. Of the strains, 59% were found by screening and 32% from clinical specimens, the latter were most commonly urine. Travel and/or hospitalization history abroad was reported for 108/171 strains (63%). The most common species were Klebsiella pneumoniae (45%), Escherichia coli (40%), and Citrobacter freundii (6%), and the most common carbapenemase genes bla NDM-like (35%), bla OXA-48-like (33%), and bla KPC-like (31%). During 2012-2018, the annual number of CPE strains increased from 9 to 70 and different sequence types from 7 to 33, and bla OXA-48-like genes became the most prevalent. Of the clusters, 3/8 were linked to traveling or hospitalization abroad and 5/8 were caused by K. pneumoniae clone clonal complex 258. Most of the clusters were caused by K. pneumoniae producing KPC. High variety among different sequence types indicates that majority of CPE cases detected in Finland are likely imported from foreign countries. Nearly one-third of the cases are not found by screening suggesting that there is hidden transmission occurring in the healthcare settings.

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Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012–2018

Räisänen

Lyytikäinen

Kauranen

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…showed a high percentage of carbapenem resistance among CA infections, especially in LRTI and BSI. In a UK study, the prevalence of carbapenem resistance in clinically relevant K. pneumoniae specimens was also due primarily to community-acquired isolates (70%) [15]. The EU mean of carbapenem resistance in invasive K. pneumonia e isolates increased from 2012 to 2015 to 8%.…”

Section: Discussionmentioning

confidence: 99%

Incidence of infections due to third generation cephalosporin-resistant Enterobacteriaceae - a prospective multicentre cohort study in six German university hospitals

Rohde

Zweigner

Wiese-Posselt

et al. 2018

Antimicrob Resist Infect Control

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BackgroundInfections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem. We aim to describe the 3GCREB infection incidence and compare it to prevalence upon admission. In addition, we aim to describe infections caused by 3GCREB, which are also carbapenem resistant (CRE).MethodsIn 2014–2015, we performed prospective 3GCREB surveillance in clinically relevant patient specimens (screening specimens excluded). Infections counted as hospital-acquired (HAI) when the 3GCREB was detected after the third day following admission, otherwise as community-acquired infection (CAI).ResultsOf 578,420 hospitalized patients under surveillance, 3367 had a 3GCREB infection (0.58%). We observed a similar 3GCREB CAI and HAI incidence (0.28 and 0.31 per 100 patients, respectively). The most frequent pathogen was 3GCR E. coli, in CAI and HAI (0.15 and 0.12 per 100 patients). We observed a CRE CAI incidence of 0.006 and a HAI incidence of 0.008 per 100 patients (0.014 per 1000 patient days).ConclusionsComparing the known 3GCREB admission prevalence of the participating hospitals (9.5%) with the percentage of patients with a 3GCREB infection (0.58%), we conclude the prevalence of 3GCREB in university hospitals to be about 16 times higher than suggested when only patients with 3GCREB infections are considered. Moreover, we find the HAI and CAI incidence caused by CRE in Germany to be relatively low.

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“…In addition, transmission can occur indirectly, through shared equipment or contaminated environmental surfaces [15]. CPB are prevalent worldwide, however differences in prevalence exist between and within continents and countries [16–20]. In the Netherlands, patients are occasionally diagnosed with CBP, mainly following hospital admission abroad [21].…”

Section: Introductionmentioning

confidence: 99%

Perceived barriers and enablers for preventing the spread of carbapenem producing gram-negative bacteria during patient transfers: a mixed methods study among healthcare providers

et al. 2019

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BackgroundAntimicrobial resistance (AMR) increasingly threatens public health. Carbapenem-producing gram-negative bacteria (CPB) pose the biggest threat. The risk for CPB spread is heightened during the transfer of a CPB-positive patient between different healthcare institutions or healthcare providers. We aimed to gain insight into the frequency of CPB-positive patients in the Dutch provinces of Noord-Holland (NH) and Flevoland (FL). Secondly, we aimed to obtain a deeper understanding of the communication between healthcare providers during transfers of CPB-positive patients and explore possible communication-related risk situations for CPB spread.MethodsThis mixed-methods study consisted of a quantitative and qualitative section. For the quantitative section, 14 laboratories that provide diagnostics in NH and FL voluntarily reported carbapenem-producing Enterobacteriaceae (CPE) positive patients between February 2018 and February 2019. Additionally, two laboratories reported carbapenem-resistant Acinetobacter spp. (CRA) and carbapenem-resistant Pseudomonas aeruginosa (CRP) positive patients. For the qualitative section, healthcare providers of reported patients were interviewed about information exchange during patient transfers, precautionary measures and knowledge and beliefs concerning CPB.ResultsIn total, 50 CPE-positive, 10 CRA-positive and 4 CRP-positive patients were reported during the inclusion period. Eighteen index-specific and 2 general interviews were conducted with 20 different care providers of 9 patients. The interviews revealed that, in most cases, information concerning the patient was transferred timely, but often a standardized method for sharing the information within and between institutions was lacking. Factors that enhanced care providers’ motivation to adhere to precautionary measures were taking responsibility for the health of other patients, (pregnant) colleagues and for ones own health. Factors that reduced motivation were not acknowledging the relevance of the precautionary measures, a perceived negative impact of the measures on patients’ recovery, differences in precautionary measures between healthcare settings and incomprehension for changes in precautionary measures.ConclusionsCPB-positivity occurred more frequently than expected in the Dutch provinces of NH and FL. Standardizing the transference of information concerning CPB-positive patients, implementing transmural agreements, training personnel on CPB knowledge and procedures, launching a national website on CPB and assigning one or several designated employees for CPB within healthcare institutions could improve communication between healthcare providers and thereby decrease the risk of CPB transmission.

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Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures

Abstract: The UK prevalence and incidence of clinically significant CPE is currently low, but these MDR bacteria affect most UK regions. Improved IPC measures, vigilance and monitoring are required.

Cited by 44 publications

References 21 publications

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012–2018

Molecular epidemiology of carbapenemase-producing Enterobacterales in Finland, 2012–2018

Incidence of infections due to third generation cephalosporin-resistant Enterobacteriaceae - a prospective multicentre cohort study in six German university hospitals

Perceived barriers and enablers for preventing the spread of carbapenem producing gram-negative bacteria during patient transfers: a mixed methods study among healthcare providers

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