| Summary: | <h4>Background</h4> <p>Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging threat to healthcare providers worldwide.</p> <h4>Objectives</h4> <p>To determine CPE carriage rates and risk factors in an unselected hospital cohort at the time of admission.</p> <h4>Methods</h4> <p>We approached 4567 patients within 72 hours 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.</p> <h4>Results</h4> <p>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 2 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 hospitalisation was the only significant risk factor for CPE carriage (p<0.001, OR 64.3, 95% CI 7.3-488.5).</p> <h4>Conclusions</h4> <p>This study highlights a very low carriage rate of CPE. Hospitalisation abroad is the most important risk factor to guide admission screening in this low prevalence setting.</p>
|
|---|