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J Antimicrob Chemother. 2016 Dec;71(12):3556-3561. Epub 2016 Aug 11.

Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting.

Author information

1
Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
2
Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK simon.goldenberg@gstt.nhs.uk.

Abstract

BACKGROUND:

Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging threat for healthcare providers worldwide.

OBJECTIVES:

To determine CPE carriage rates and risk factors in an unselected hospital cohort at the time of admission.

METHODS:

We approached 4567 patients within 72 h of admission to provide a rectal swab and answer a questionnaire on risk factors for carriage. Rectal swabs were cultured for carbapenem-resistant organisms on chromogenic and non-chromogenic agar, and tested for carbapenemase production by PCR (Check-Direct CPE). The study was approved by the NHS Research Ethics Committee.

RESULTS:

Only 6 CPE were cultured from 5 (0.1%) of 4006 patients who provided a rectal swab; only 1 was cultured using non-chromogenic media. An additional 76 culture-negative rectal swabs were initially PCR positive, but none grew a carbapenem-resistant organism despite enrichment culture and only two were positive when retested several months later by Check-Direct and a second PCR assay (Cepheid GeneXpert® Carba-R). A modified Ct cut-off of <35 would have resolved these apparent false-positives. 40% of patients had a risk factor that should prompt screening and pre-emptive isolation as defined by UK CPE guidelines but only 8.1% and 20.2% of these patients had been screened and pre-emptively isolated by clinical teams, respectively. Overseas hospitalization was the only significant risk factor for CPE carriage (P < 0.001, OR 64.3, 95% CI 7.3-488.5).

CONCLUSIONS:

This study highlights a very low carriage rate of CPE. Hospitalization abroad is the most important risk factor to guide admission screening in this low-prevalence setting.

PMID:
27516471
PMCID:
PMC5890656
DOI:
10.1093/jac/dkw309
[Indexed for MEDLINE]
Free PMC Article

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