carbapenemase producing enterobacteriaceae (cpe) · • cpe reference laboratory service do tests...
TRANSCRIPT
Carbapenemase Producing Enterobacteriaceae (CPE)
HSE | HCAI/AMR Programme
Martin Cormican
HSE National Lead for
Health Care Associated Infection and Antimicrobial Resistance
The Next Ten Minutes of Your Life
Background – What is CPE & why it matters
Process & Categories
Information
Summary
Commentary
Thanks
Background: “The Lamps Are Going Out All Over
Europe” (Sir Edward Grey 1914)
Background: Faecal Oral Spread
CPE – faecal oral spread
If someone got CPE they swallowed traces of someone else’s faeces
That should happen a lot less often in
health care delivery than it does
Background: CPE: What it is
First the E = Enterobacteriaceae
E: = normal gut bugs
E: a group of bacteria that belong normally in the gut (normal colonisation)
But: Can get into urine (cystitis/pyelonephritis), gall bladder (cholecystitis) and blood (blood stream infection/septicaemia)
Background: Now the C in CPE: What it is
Carbapenems (a family of antibiotics) meropenem is best
know example in Ireland
C = Carbapenem”ase” – an enzyme that destroys
carbapenem
Background: So CPE: What is it ?
C = Carbapenemase
P = Producing
E = gut bugs
(The term CRE is widely used means more or less the same
thing most of the time)
Background: CPEs Come In Different Colours
(this is not an endorsement of smarties, Nestlé, or any other food high in refined sugar (although I do like smarties I like giant chocolate buttons even more but they are all
the same colour so they were not suitable to illustrate this point)
OXA
KPC
NDM
The Process
• Sample from patient in hospital X (screening /diagnostic) • Clinical laboratory do a test (different ways to do this) • They think is a CPE (or know it’s a CPE) • They send the bacteria with relevant data to CPE Reference
Laboratory Service • CPE Reference Laboratory Service do tests to confirm it is CPE • Coverage: • Estimate that more than 90% of CPE that are found are submitted
within a week to 10 days
The Categories of Sample
• Blood stream = Life threatening infection
• Rectal/faeces = Colonisation
• Other (wound swab, urine, sputum, etc) submitted within a week to 10 days = Colonisation or Infection
The Numbers - Ireland(*)
Total CPE Blood Stream Infections
based on reference laboratory data
(will need cross check)
The Numbers - Ireland(*)
To End of October
332 people newly detected with
CPE
Plus so far in November 33 more
Every hospital group except
childrens
Total - 365
RCSI Hospital Group
Ireland East
Dublin Midlands
Children’s Hospital Group
Different Colour of the Smarties
South Southwest Hospital Group
University of Limerick Hospital Group
Saolta Hospital Group
Summary
• Almost all hospitals are sending CPE to the Reference Laboratory Service (one major exception)
• Our data is reasonably timely and reasonably accurate representation of what is detected by clinical laboratories
• CPE is very widely disseminated • On average more than 1 new person every day is getting CPE • The numbers detected by some hospitals suggest that it is higly likely
that they do not have effective systems for detection • Until every hospital is doing a reasonable level of screening we do
not know how bad the situation is
Commentary
• The numbers detected by some hospitals suggest that it is highly
likely that they do not have effective systems for detection
• Until every hospital is doing a reasonable level of screening we do not know how bad the situation is
Thanks To The People Who Do The Work
Elaine McGrath (The Reference Lab Scientist)
Wendy Brennan
Maria Molloy
Tom Whyte
Background: “we shall not seem them lit again in
our life-time” (Sir Edward Grey again)