Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting.
<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 adm...
| Main Authors: | , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Oxford University Press
2016
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| _version_ | 1797099890992480256 |
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| author | Otter, J Dyakova, E Bisnauthsing, K Querol-Rubiera, A Patel, A Ahanonu, C Tosas Auguet, O Edgeworth, J Goldenberg, S |
| author_facet | Otter, J Dyakova, E Bisnauthsing, K Querol-Rubiera, A Patel, A Ahanonu, C Tosas Auguet, O Edgeworth, J Goldenberg, S |
| author_sort | Otter, J |
| collection | OXFORD |
| description | <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> |
| first_indexed | 2024-03-07T05:30:02Z |
| format | Journal article |
| id | oxford-uuid:e1f0afa9-c450-4ec9-8307-5dfa67cc0369 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:30:02Z |
| publishDate | 2016 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:e1f0afa9-c450-4ec9-8307-5dfa67cc03692022-03-27T09:57:44ZUniversal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e1f0afa9-c450-4ec9-8307-5dfa67cc0369EnglishSymplectic Elements at OxfordOxford University Press2016Otter, JDyakova, EBisnauthsing, KQuerol-Rubiera, APatel, AAhanonu, CTosas Auguet, OEdgeworth, JGoldenberg, S <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> |
| spellingShingle | Otter, J Dyakova, E Bisnauthsing, K Querol-Rubiera, A Patel, A Ahanonu, C Tosas Auguet, O Edgeworth, J Goldenberg, S Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting. |
| title | Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting. |
| title_full | Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting. |
| title_fullStr | Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting. |
| title_full_unstemmed | Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting. |
| title_short | Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting. |
| title_sort | universal hospital admission screening for carbapenemase producing organisms in a low prevalence setting |
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