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Evaluating serial screening cultures to detect carbapenemase-producing Enterobacteriaceae following hospital admission

  • Author Footnotes
    1 Joint first authors.
    S. Mookerjee
    Footnotes
    1 Joint first authors.
    Affiliations
    Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK

    National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections (HCAI) and Antimicrobial Resistance (AMR), Imperial College London, Hammersmith Hospital, London, UK
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  • Author Footnotes
    1 Joint first authors.
    E. Dyakova
    Footnotes
    1 Joint first authors.
    Affiliations
    Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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  • F. Davies
    Affiliations
    Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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  • K. Bamford
    Affiliations
    Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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  • E.T. Brannigan
    Affiliations
    Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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  • A. Holmes
    Affiliations
    Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK

    National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections (HCAI) and Antimicrobial Resistance (AMR), Imperial College London, Hammersmith Hospital, London, UK
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  • J.A. Otter
    Correspondence
    Corresponding author. Address: Imperial College London, National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections (HCAI) and Antimicrobial Resistance (AMR), Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK. Tel.: +1 020 331 33271.
    Affiliations
    Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK

    National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Healthcare-Associated Infections (HCAI) and Antimicrobial Resistance (AMR), Imperial College London, Hammersmith Hospital, London, UK
    Search for articles by this author
  • Author Footnotes
    1 Joint first authors.

      Summary

      Background

      Carbapenem-producing Enterobacteriaceae (CPE) are on the rise worldwide. National guidelines for the prevention and control of CPE recommend screening for the detection of asymptomatic carriers on admission.

      Aim

      To evaluate the benefit of serial screens for detecting the carriage of CPE and other antibiotic-resistant Gram-negative bacteria following hospital admission.

      Methods

      All CPE screens, which were cultured on chromogenic media and the presence of a carbapenemase confirmed by polymerase chain reaction, were analysed for a six-month period. National guidelines in England recommend three serial screens for CPE separated by 48 h for admission screening for ‘at-risk’ patients, during which the patient is isolated. Two screening scenarios were tested. In scenario A, patients received three screens at the specified timepoints, in line with English national guidelines; in scenario B, patients received three consecutive screens, but not necessarily within the specified timepoints, during one admission. General linear models or conditional logistic regression were used to detect any significant change in the rate of carriage.

      Findings

      There was no significant increase in the detected carriage rate of CPE across any of the three timepoints in the scenarios tested. However, there was a significant increase in the detected rate of carriage of Gram-negative bacteria, Enterobacteriaceae, and resistant Enterobacteriaceae (excluding CPE) in scenario B.

      Conclusion

      Three serial screens were not useful for the detection of CPE carriage on admission. The increase in the carriage rate of other Gram-negative bacteria may be explained by ‘unmasking’ of pre-existing carriage, or acquisition. This argues for regular screening of long-stay patients.

      Keywords

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