Infections due to CPE are associated with higher in-hospital mortality
About
- Enterobacteriaceae are normal gut bacteria
- These are resistant to antibiotics including carbapenems
Aetiology
- Carbapenemase are Enzymes (such as KPC, OXA-48, NDM and
VIM) produced by some bacteria which cause
destruction of the carbapenem antibiotics,
resulting in resistance.
Clinical
- The concerns are these bacteria are resistant and resultant infections will have no treatment
Those with organism
- Staff must be alert to the increased risk of infection or colonisation
with patient transfers/admissions from high-risk overseas countries,
including Bangladesh, the Balkans, China, Cyprus, Greece, India,
Ireland, Israel, Italy, Japan, North Africa (all), Malta, the Middle East
(all), Pakistan, South East Asia, South/Central America, Taiwan,
Turkey and the USA. This list is not exhaustive and transfers from any
hospital abroad should be risk assessed
Risk Assessment
- Is the patient a laboratory-confirmed case of carbapenemase-producing
Enterobacteriaceae infection/colonisation, during this admission
an episode or at a transferring healthcare facility?
- Has the patient in the last 12 months been an inpatient in a hospital abroad or known to have been in a UK hospital with known infection or been colonised with or been in close contact with the organism
Investigations
- A rectal swab is a specimen taken by gently
inserting a swab inside the rectum 3-4cms
beyond the anal sphincter, rotating gently and
removing. Normal saline can be used to
moisten the swab prior to insertion. The swab
should have visible faecal material to enable
organism detection in the laboratory. A rectal
swab should not be mistaken for a perineal
swab.
Management
- If they are at risk as defined then isolate the patient immediately into a side room with en-suite facilitates. Instigate strict infection control standard precautions to prevent the possible spread
- Screen to assess current status for colonisation or infection and assessment for appropriate treatment (applies to infection only). Alert the IP&CT
- If the patient is POSITIVE on screening for carbapenemase-producing
Enterobacteriaceae or is a laboratory-confirmed case (colonisation or
infection) they should remain in isolation for the duration of their hospital stay
- Treatment of the patient with an infection caused by
carbapenemase-producing Enterobacteriaceae should be under the advice of
the microbiologist
References