Carbapenemase-producing Enterobacteriaceae (CPE) control in practice: Mapping the possible opportunities for control in retrospectively-identified outbreaks in a tertiary hospital.

Ms Alex Marmor2, Dr Kathryn Daveson1, Associate Professor David Harley3, Dr Karina Kennedy2

1The Canberra Hospital, ACT Health, Garran, Australia,

2Australian National University, Acton, Australia,

3Queensland Centre for Intellectual Development & Disability, Raymond Terrace , Australia

Introduction

Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant problem for antimicrobial resistance control in Australia.  Surveillance and control guidance documents have been developed to aid in healthcare associated CPE control. In limited resource settings, these are perceived to be labour and cost burdensome, so the impact of these control measures is important.  The aim of the study was to review the likely impact of the suggested control measures on the progression and control of two retrospectively-identified CPE outbreaks.

Methods

The Victorian guideline on carbapenemase-producing Enterobacteriaceae (2015) was theoretically applied to two molecularly-identified CPE outbreaks at the Canberra Hospital.  Future CPE cases identified and prevented cases were estimated from the available epidemiological data.

Results

The implementation of strategies for control for facilities with sporadic cases at first CPE detection could not have prevented the majority of cases of Outbreak 1.  Application of controls for facilities with local transmission instead may have prevented two thirds of cases.  For Outbreak 2, application of controls for facilities with local transmission would have prevented the majority (7/9) of Outbreak 2 cases, assuming 100% screening sensitivity.

Conclusion

Retrospective analysis of CPE control guidelines using outbreak data may help to evaluate their utility and inform their revision for future use.  Escalation or broadening of the Victorian guideline in the early phases to include more intensive surveillance approaches may be more advantageous in control of CPE outbreaks based on current estimations.


Biography:

Kathryn Daveson is an infectious disease physician who works across the ACT and Qld in the areas of clinical infectious diseases and antimicrobial stewardship.