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Freeman R, Ironmonger D, Hopkins KL, Puleston R, Staves P, Hope R, Muller-Pebody B, Brown CS, Hopkins S, Johnson AP, Woodford N, Oliver I. Epidemiology of carbapenemase-producing Enterobacterales in England, May 2015-March 2019: national enhanced surveillance findings and approach. Infect Prev Pract 2020; 2:100051. [PMID: 34368709 DOI: 10.1016/j.infpip.2020.100051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
Background In response to increasing numbers of carbapenemase-producing Enterobacterales (CPE) in England, Public Health England (PHE) launched an electronic reporting system (ERS) for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria. Our study aimed to describe system engagement and the epidemiology of CPE in England. Methods Engagement with the ERS was assessed by calculating the proportion of referrals submitted this system. ERS data were extracted and cases defined as patients with CPE isolated from a screening or clinical specimen in England between 1st May 2015 to 31st March 2019. Descriptive summary statistics for each variable were prepared. Results The ERS processed 12,656 suspected CPE reports. Uptake of the ERS by local microbiology laboratories varied, with approximately 70% of referrals made via the ERS by April 2016; this steadily decreased after March 2018. Six-thousand eight-hundred and fifty-seven cases were included in the analysis. Most cases were from colonised patients (80.6%) rather than infected, and the majority were inpatients in acute hospital settings (87.3%). Carbapenemases were most frequently detected in Klebsiella pneumoniae (39.1%) and Escherichia coli (30.3%). The most frequently identified carbapenemase families were OXA-48-like (45.1%) and KPC (26.4%). Enhanced data variables were poorly completed. Conclusions The ERS has provided some insight into the epidemiology of CPE in England. An increasing number of routine diagnostic laboratories have introduced methods to routinely identify acquired carbapenemases and PHE has modified its approach to ensure robust surveillance, which is an essential aspect of an effective response to prevent and control the spread of CPE.
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Affiliation(s)
- Rachel Freeman
- National Infection Service, Public Health England, London, UK
| | - Dean Ironmonger
- National Infection Service, Public Health England, Birmingham, UK
| | - Katie L Hopkins
- National Infection Service, Public Health England, London, UK
| | - Richard Puleston
- National Infection Service, Public Health England, Nottingham, UK
| | - Peter Staves
- National Infection Service, Public Health England, London, UK
| | - Russell Hope
- National Infection Service, Public Health England, London, UK
| | | | - Colin S Brown
- National Infection Service, Public Health England, London, UK
| | - Susan Hopkins
- National Infection Service, Public Health England, London, UK
| | - Alan P Johnson
- National Infection Service, Public Health England, London, UK
| | - Neil Woodford
- National Infection Service, Public Health England, London, UK
| | - Isabel Oliver
- National Infection Service, Public Health England, Bristol, UK
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Jermacane D, Coope CM, Ironmonger D, Cleary P, Muller-Pebody B, Hope R, Hopkins S, Puleston R, Freeman R, Hopkins KL, Johnson AP, Woodford N, Oliver I. An evaluation of the electronic reporting system for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria in England. J Hosp Infect 2019; 102:17-24. [PMID: 30641097 DOI: 10.1016/j.jhin.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND An electronic reporting system (ERS) for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria (CPGNB) was launched by Public Health England in May 2015. AIM This evaluation aimed to assess uptake, timeliness and completeness of data provided and explore potential barriers and facilitators to adopting the system. METHODS The evaluation comprised a retrospective analysis of surveillance data and semi-structured interviews with ERS users. FINDINGS The proportion of organisms referred for investigation of carbapenem resistance via ERS increased over the first 12 months post-implementation from 35% to 73%; uptake varied widely across regions of England. Completeness of enhanced data fields was poor in 78% of submitted isolates. The median number of days to report confirmatory test results via ERS was 1 day for the regional service and nine days for the national reference laboratory, which additionally conducts phenotypic testing to confirm carbapenemase negativity. Hindrances to ERS utility included: a lack of designated, ongoing resource for system maintenance, technical support and development; uncertainty about how and when to use ERS and workload. Incomplete data prevented gaining a better understanding of important risk factors and transmission routes of CPGNB in England. CONCLUSION The ERS is the only surveillance system in England with the potential to gather intelligence on important risk factors for CPGNB to inform public health measures to control their spread. Although the ERS captures more information on CPGNB than other surveillance systems, timeliness and completeness of the enhanced data require substantial improvements in order to deliver the desired health benefits.
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Affiliation(s)
- D Jermacane
- Field Service, National Infection Service, Public Health England, UK
| | - C M Coope
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.
| | - D Ironmonger
- Field Service, National Infection Service, Public Health England, UK
| | - P Cleary
- Field Service, National Infection Service, Public Health England, UK
| | - B Muller-Pebody
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Hope
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - S Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Puleston
- Field Service, National Infection Service, Public Health England, UK
| | - R Freeman
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - K L Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - A P Johnson
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - N Woodford
- National Infection Service Laboratories, Public Health England, London, UK
| | - I Oliver
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
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Bouza E, Muñoz P, Burillo A. Role of the Clinical Microbiology Laboratory in Antimicrobial Stewardship. Med Clin North Am 2018; 102:883-898. [PMID: 30126578 DOI: 10.1016/j.mcna.2018.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
For adequate antimicrobial stewardship, microbiology needs to move from the laboratory to become physically and verbally amenable to the caregivers of an institution. Herein, we describe the contributions of our microbiology department to the antimicrobial stewardship program of a large teaching hospital as 10 main points ranging from the selection of patients deemed likely to benefit from a fast track approach, to their clinical samples, or the rapid reporting of results via a microbiology hotline, to rapid searches for pathogens and susceptibility testing. These points should serve as guidelines for similar programs designed to decrease the unnecessary use of antimicrobials.
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Affiliation(s)
- Emilio Bouza
- Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal s/n, Madrid 28040, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, Madrid 28007, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, Madrid 28007, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Doctor Esquerdo 46, Madrid 28007, Spain.
| | - Patricia Muñoz
- Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal s/n, Madrid 28040, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, Madrid 28007, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, Madrid 28007, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Doctor Esquerdo 46, Madrid 28007, Spain
| | - Almudena Burillo
- Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal s/n, Madrid 28040, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, Madrid 28007, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, Madrid 28007, Spain
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Gautier G, Guillard T, Podac B, Bercot B, Vernet-Garnier V, de Champs C. Detection of different classes of carbapenemases: Adaptation and assessment of a phenotypic method applied to Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii, and proposal of a new algorithm. J Microbiol Methods 2018; 147:26-35. [PMID: 29486226 DOI: 10.1016/j.mimet.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 10/18/2022]
Abstract
A new phenotypic method for detecting carbapenemases has been adapted (assembling of two MAST® kits, including one that contains faropenem to which a temocillin disk has been added) then assessed using 101 bacterial strains (Enterobacteriaceae with assays on Pseudomonas aeruginosa and Acinetobacter baumannii) including 62 which produce genetically identified carbapenemases. Concerning Carbapenemase-Producing Enterobacteriaceae (CPE), there is 100% sensitivity for Klebsiella pneumoniae carbapenemase (KPC, Ambler class A) and OXA-48 (Ambler class D), and 91% for metallo-beta-lactamase (MBL, Ambler class B), with a 97% sensitivity for all carbapenemases, with a specificity of 100%. The test is also efficient for detecting Pseudomonas aeruginosa carbapenemases (sensitivity between 82 and 100% and 100% specificity). The major innovation is the combined use of faropenem and temocillin for reliable detection (excellent performance with 100% sensitivity and specificity) of OXA-48. This study has led to the development of a new algorithm to detect the different classes of carbapenemases, for first-line diagnosis, by combining this modified MAST® test with immunochromatographic methods and molecular biology techniques.
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Affiliation(s)
- Guillaume Gautier
- Bacteriology-Virology-Hygiene Department, Bacteriology Unit, Robert Debré University Hospital, avenue du général Koenig, 51092 Reims Cedex, France; Medical Biology Laboratory, Microbiology Department, Bacteriology Unit, William Morey General Hospital, 4 rue capitaine Drillien, 71321 Chalon-sur-Saône Cedex, France.
| | - Thomas Guillard
- Bacteriology-Virology-Hygiene Department, Bacteriology Unit, Robert Debré University Hospital, avenue du général Koenig, 51092 Reims Cedex, France; Research Unit EA 4687 SFR Cap-Santé (FED 4231), Acquired Resistance in Enterobacteriaceae, Reims Champagne-Ardenne University, 51 rue Cognacq-Jay, 51095 Reims Cedex, France.
| | - Bianca Podac
- Medical Biology Laboratory, Microbiology Department, Bacteriology Unit, William Morey General Hospital, 4 rue capitaine Drillien, 71321 Chalon-sur-Saône Cedex, France.
| | - Béatrice Bercot
- AP-HP, Saint-Louis-Lariboisière-Fernand-Widal Hospital Group, Laboratory of Bacteriology, associated for the National Reference Center for gonococci, 1 avenue Claude Vellefaux, 75010 Paris, France; IAME, UMR 1137, INSERM, Paris Diderot University, 16 rue Henri Huchard, 75890 Paris Cedex 18, France.
| | - Véronique Vernet-Garnier
- Bacteriology-Virology-Hygiene Department, Bacteriology Unit, Robert Debré University Hospital, avenue du général Koenig, 51092 Reims Cedex, France; Research Unit EA 4687 SFR Cap-Santé (FED 4231), Acquired Resistance in Enterobacteriaceae, Reims Champagne-Ardenne University, 51 rue Cognacq-Jay, 51095 Reims Cedex, France.
| | - Christophe de Champs
- Bacteriology-Virology-Hygiene Department, Bacteriology Unit, Robert Debré University Hospital, avenue du général Koenig, 51092 Reims Cedex, France; Research Unit EA 4687 SFR Cap-Santé (FED 4231), Acquired Resistance in Enterobacteriaceae, Reims Champagne-Ardenne University, 51 rue Cognacq-Jay, 51095 Reims Cedex, France.
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