Addressing the emerging challenge of CPE
Inadequate measures to prevent and control transmission of CPE can have serious consequences for both patients; who may require more complex treatment to manage their infection, and hospitals in terms of ward closures and protracted patient stays. CPR has been the subject of a stage 2 NHS England Alert and remains an issue of great concern and high priority. Our work to date has assessed strategies for CPE control, including national screening and isolation recommendations and has provided economic analyses of the impact of outbreak control in the NHS. Research also demonstrated that antimicrobial consumption data can provide a potential tool for forecasting emergence of CPE and how routine NHS data can be used for effective surveillance.
Our own local CPE screening guidelines have been developed based upon our research findings which found that serial screen to not improve CPE detection. Our recent work has shown that antibiotic-resistant bacteria are commonly acquired outside of hospital settings which highlights the need for prevention methods within the community.
Examination of the ICHT 2014/2015 K. pneumonia blaNDM outbreak revealed that two-thirds of isolates were colistin resistant as the result of a chromosomal mutation. This again has influenced the local microbiology laboratory which has subsequently performed an extensive evaluation of current colistin susceptibility testing methods to identify appropriate protocols. Members of the team are currently contributing to a national advisory group review of gram-negative resistance treatment and definition guidelines.
Otter, J. A, Michel Doumith, Frances Davies, et al, Emergence and clonal spread of colistin resistance due to multiple mutational mechanisms in carbapenemase-producing Klebsiella pneumoniae in London, Scientific Reports. 7: 12711 2017
Hawkey, P.M. Roderic E. Warren, et al , Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party. 2018, Journal of Antimicrobial Chemotherapy. 73: iii2–iii78
Mookerjee, S Dyakova E, Davies F et al, Evaluating serial screening cultures to detect carbapenemase-producing Enterobacteriaceae following hospital admission. Journal of Hospital Infection. 100:15-20.
Knight, G.M. Céire Costelloe, Sarah R. Deeny et al Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study 2018. BMC Medcine 16:137.
Otter JA, Burgess P, Davies F, et al, Counting the cost of an outbreak of carbapenemase-producing Enterobacteriaceae: an economic evaluation from a hospital perspective. Clinical Microbiology and Infection, November 2016
Vella V, Moore LS, Robotham JV, Davies F, et al, Isolation demand from carbapenemase-producing Enterobacteriaceae screening strategies based on a West London hospital network Journal of Hospital Infection. April 2016.
Gharbi M, Moore LSP, Gilchrist M, et al, Forecasting carbapenem resistance from antimicrobial consumption surveillance: lessons learnt from an OXA-48 producing Klebsiella pneumoniae outbreak in a London renal unit. International Journal of Antimicrobial Agents. Aug 2015
Freeman R, Moore LSP, Charlett A, et al, Exploring the epidemiology of carbapenem-resistant Gram-negative bacteria in west London and the utility of routinely collected hospital microbiology data. Journal of Antimicrobial Chemotherapy. 2015 April.
Birgand G, Moore LSP, Bourigault C, et al, Measures to eradicate multidrug-resistant organism outbreaks: How much does it cost? Clinical Microbiology and Infection. October 2015