T H E L A T E S T I N T H E G R O W I N G L I S T O F S U P E R B U G S

Carbapenemase-producing Enterobacteriaceae (CRE)

CRE

Enterobacteriaceae

(Gram Negative Bacilli)

Citrobacter species

Escherichia coli***

Klebsiella species***

Morganella species

Proteus species

Serratia marcescens

Enterobacter species

Carbapenem

Last line antibiotic used to treat multi drug resistant bacteria

Carbapenemaiseproducing

Bacteria that produce an enzyme that inactivates Carbapenem antibiotics

Spread in Europe 2013-2015

Consumption varies widely between

countries

10. Goossens et al .Clin Infect Dis 2007; 44(8):1091-1095

Note: graph

represents per

capita

consumption

CRE

Infections associated with crude mortality rates of 44-70%.

7% of K. pneumoniae BSIs reported to the European Antimicrobial Resistance Surveillance Network (EARS-Net) in 2014 were carbapenem- resistant

Endemic in Europe (apart from Iceland), India, North and South America

Not Just in Healthcare

Via the faecal-oral route (foodborne or waterborne transmission)

Hospital sewage in China, Spain and Brazil

Regular sewage on Barbados

River water in Portugal

Retail chicken meat in Egypt

Fresh vegetables and spices imported from Asia.

So what?

Normal FloraThese bacteria are part of the normal flora of the gut

While in the gut no problem however once they get into the blood stream, wound, urinary tract limited/ no treatment options

Promiscuous bacteriaHappy to share genetic codes and therefore enable other bacteria to produce the enzyme

Deadly superbug CRE, kills two in Melbourne, spreads across Victoria, infecting 60June 17, 2015 11:07amHerald Sun

In Victoria since 2012, KPC-producing Klebsiellapneumoniae isolates have increased. Epidemiological data and genomic analysis of clusters indicate

local transmission.

Healthcare-associated spread has occurred – genomic clusters have a strong or exclusive relationship with specific health service

Ongoing community transmission has not been recognised

CPE are not believed to be endemic in Victoria

Vital to introduce proactive measures to prevent, detect and contain CPE.

2015 first case of hospital transmission in Victoria.

CPE in Victoria

Risk Factors of Acquiring CRE

Risk factors considered to be associated with an increased risk of becoming colonisedwith CPE are:

Hospital stay within the previous 12 months in an area with documented or suspected CPE e.g. an overseas country or transmission risk area

Prolonged hospital stay Multiple or recent exposures to different antibiotic agents

including extended-spectrum penicillins, cephalosporins, fluoroquinolones and carbapenems

Diabetes mellitus Indwelling medical device

such as a central venous catheter, urinary catheter, biliary catheter or wound drain Organ or stem-cell transplant Admission to the intensive care unit Mechanical ventilation Poor functional status

RING ANY ALARM BELLS???

Pre-emptive Isolation and Screening (PRIS)

Contact precautions and screening are always required on admission to a Victorian health serviceIncludes: Direct transfer from an overseas

hospital Overnight stay in an overseas

hospital or residential care facility in previous 12 months

A room contact of a CPE case who has not achieved criteria for being ‘cleared’

A ward contact of a CPE case from a transmission risk area who has not achieved criteria for being ‘cleared’

1. Faecal specimen2. Rectal swab & inguinal swab

How did we get here? Poor Prescribing

Gentamycin for IDC

Surgical Prophylaxis for over 24 hours

Treatment of asymptomatic UTI’s

Just in case

No pathology Orthopaedic Dictionary

heart \härt\ noun: pump for keflin.

What can we do?

Minimise the need for antibiotics and reduce the spread of bacteria by:

Getting the basics right

Aseptic technique

Hand hygiene

Clean environment

Clean equipment

Invasive device management

Review antibiotics at a clinical level

Be proactive!

Thank you, Any questions?