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Carbapenemase screening in an Irish tertiary referral hospital: Best practice, or can we do better?
S Fahy1,2, J A O'Connor1, D O'Brien1
1Department of Clinical Microbiology, Mercy University Hospital, Cork, Ireland.
Insights
Carbapenemase-producing Enterobacterales (CPE) screening in hospitals is effective. Universal screening helps identify carriers quickly, reducing potential contacts and costs associated with external lab confirmations.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Public Health
Background:
- Carbapenems are crucial last-resort antibiotics.
- Rising carbapenem resistance poses a significant global health threat.
- Effective screening programs are vital for infection control.
Purpose of the Study:
- To evaluate the effectiveness of a hospital's carbapenemase-producing Enterobacterales (CPE) screening program.
- To assess the program's alignment with national guidelines (NHS).
- To analyze the efficiency and cost-effectiveness of the screening process.
Main Methods:
- Implemented a universal screening program over 26 months.
- Utilized rectal swabs cultured on arrival.
- Employed NG-Carba 5 lateral flow tests and Vitek 2.0 for confirmation.
- Compared screening practices against NHS guidelines.
Main Results:
- Detected 53 true positive CPE cases from 45 patients.
- Observed a decrease in positive screens as screening rates increased.
- Found similarities between hospital and national guidelines.
- Demonstrated universal screening's effectiveness in reducing contacts and identifying carriers.
- Identified external lab confirmation as costly and time-consuming.
Conclusions:
- The hospital's universal CPE screening program is effective and efficient.
- In-house confirmatory testing is adequate for routine screens.
- Infection prevention and control are paramount in managing hospital outbreaks.
- Standardized practices across hospitals could improve overall CPE detection and control.
Background:
Carbapenems are a family of end line antibiotics with increasing levels of resistance that are a cause for concern.
Aim:
To ascertain whether the CPE screening programme employed in an acute tertiary hospital is fit for purpose.
Method:
We outlined the current working algorithm employed using a universal screening programme over a 26-month screening period. Rectal swabs are cultured on arrival. Those with suspicious growth are further investigated using NG-Carba 5 lateral flow tests and Vitek 2.0 sensitivity cards. These practices were compared with NHS guidelines.
Findings & Conclusions:
In all, 53 true positives were detected from 45 patients since the screening was implemented in early 2018 (46 OXA-48, 6 KPC, 1 NDM). As the rate of screening increased, the number of positive screens decreased over time. There were a lot of similarities between the HSE guidelines and the published NHS CPE toolkit. It was evident that there is no standard practice being employed across all hospitals. Comparing the MUH to national guidelines it appears to be quicker and more effective with universal screening in place at reducing the potential contacts and identifying carriers. Cost analysis indicates that the need to confirm all positive strains in a reference lab is costly, unnecessary and time consuming. There are adequate confirmatory tests available in-house for routine positive screens. It was concluded that infection prevention and control are key to identifying and controlling possible outbreaks in a hospital setting.
