Carbapenemase-producing Enterobacteriaceae (CRE) T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S
CRE Enterobacteriaceae (Gram Negative Bacilli) Citrobacter species Escherichia coli*** Klebsiella species*** Morganella species Proteus species Serratia marcescens Enterobacter species Carbapenem Last line antibiotic used to treat multi drug resistant bacteria Carbapenemaise producing Bacteria that produce an enzyme that inactivates Carbapenem antibiotics
Spread in Europe 2013-2015
Consumption varies widely between countries Note: graph represents per capita consumption 10. Goossens et al.clin Infect Dis 2007; 44(8):1091-1095
CRE Infections associated with crude mortality rates of 44-70%. 7% of K. pneumoniae BSIs reported to the European Antimicrobial Resistance Surveillance Network (EARS-Net) in 2014 were carbapenem- resistant Endemic in Europe (apart from Iceland), India, North and South America
Not Just in Healthcare Via the faecal-oral route (foodborne or waterborne transmission) Hospital sewage in China, Spain and Brazil Regular sewage on Barbados River water in Portugal Retail chicken meat in Egypt Fresh vegetables and spices imported from Asia.
Normal Flora These bacteria are part of the normal flora of the gut While in the gut no problem however once they get into the blood stream, wound, urinary tract limited/ no treatment options So what? Promiscuous bacteria Happy to share genetic codes and therefore enable other bacteria to produce the enzyme Deadly superbug CRE, kills two in Melbourne, spreads across Victoria, infecting 60 June 17, 2015 11:07am Herald Sun
CPE in Victoria In Victoria since 2012, KPC-producing Klebsiella pneumoniae isolates have increased. Epidemiological data and genomic analysis of clusters indicate local transmission. Healthcare-associated spread has occurred genomic clusters have a strong or exclusive relationship with specific health service Ongoing community transmission has not been recognised CPE are not believed to be endemic in Victoria Vital to introduce proactive measures to prevent, detect and contain CPE. 2015 first case of hospital transmission in Victoria.
Risk Factors of Acquiring CRE Risk factors considered to be associated with an increased risk of becoming colonised with CPE are: Hospital stay within the previous 12 months in an area with documented or suspected CPE e.g. an overseas country or transmission risk area Prolonged hospital stay Multiple or recent exposures to different antibiotic agents including extended-spectrum penicillins, cephalosporins, fluoroquinolones and carbapenems Diabetes mellitus Indwelling medical device such as a central venous catheter, urinary catheter, biliary catheter or wound drain Organ or stem-cell transplant Admission to the intensive care unit Mechanical ventilation Poor functional status RING ANY ALARM BELLS???
Pre-emptive Isolation and Screening (PRIS) 1. Faecal specimen 2. Rectal swab & inguinal swab Contact precautions and screening are always required on admission to a Victorian health service Includes: Direct transfer from an overseas hospital Overnight stay in an overseas hospital or residential care facility in previous 12 months A room contact of a CPE case who has not achieved criteria for being cleared A ward contact of a CPE case from a transmission risk area who has not achieved criteria for being cleared
How did we get here? Poor Prescribing Gentamycin for IDC Surgical Prophylaxis for over 24 hours Treatment of asymptomatic UTI s Just in case No pathology Orthopaedic Dictionary heart \härt\ noun: pump for keflin.
What can we do? Minimise the need for antibiotics and reduce the spread of bacteria by: Getting the basics right Aseptic technique Hand hygiene Clean environment Clean equipment Invasive device management Review antibiotics at a clinical level Be proactive!
Thank you, Any questions?