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The Journal of antimicrobial chemotherapy v.72 no.2, 2017년, pp.596 - 603   SCI SCIE
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Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures

Trepanier, Pascale (Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK ) ; Mallard, Kim (Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK ) ; Meunier, Danièle (Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK ) ; Pike, Rachel (Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK ) ; Brown, Derek (Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK ) ; Ashby, Janet P. (City Hospital, Dudley Road, Birmingham B18 7QH, UK ) ; Donaldson, Hugo (Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK ) ; Awad-El-Kariem, F. Mustafa (East and North Hertfordshire NHS Trust, Lister District G ) ; Balakrishnan, Indran ; Cubbon, Marc ; Chadwick, Paul R. ; Doughton, Michael ; Doughton, Rachael ; Hardiman, Fiona ; Harvey, Graham ; Horner, Carolyne ; Lee, John ; Lewis, Jonathan ; Loughrey, Anne ; Manuel, Rohini ; Parsons, Helena ; Perry, John D. ; Vanstone, Gemma ; White, Graham ; Shetty, Nandini ; Coia, John ; Wiuff, Camilla ; Hopkins, Katie L. ; Woodford, Neil ;
  • 초록  

    Objectives To estimate UK prevalence and incidence of clinically significant carbapenemase-producing Enterobacteriaceae (CPE), and to determine epidemiological characteristics, laboratory methods and infection prevention and control (IPC) measures in acute care facilities. Methods A 6 month survey was undertaken in November 2013–April 2014 in 21 sentinel UK laboratories as part of the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project. Up to 10 consecutive, non-duplicate, clinically significant and carbapenem-non-susceptible isolates of Escherichia coli or Klebsiella pneumoniae were submitted to a reference laboratory. Participants answered a questionnaire on relevant laboratory methods and IPC measures. Results Of 102 isolates submitted, 89 (87%) were non-susceptible to ≥1 carbapenem, and 32 (36%) were confirmed as CPE. CPE were resistant to most antibiotics, except colistin (94% susceptible), gentamicin (63%), tigecycline (56%) and amikacin (53%). The prevalence of CPE was 0.02% (95% CI = 0.01%–0.03%). The incidence of CPE was 0.007 per 1000 patient-days (95% CI = 0.005–0.010), with north-west England the most affected region at 0.033 per 1000 patient-days (95% CI = 0.012–0.072). Recommended IPC measures were not universally followed, notably screening high-risk patients on admission (applied by 86%), using a CPE ‘flag’ on patients’ records (70%) and alerting neighbouring hospitals when transferring affected patients (only 30%). Most sites (86%) had a laboratory protocol for CPE screening, most frequently using chromogenic agar (52%) or MacConkey/CLED agars with carbapenem discs (38%). Conclusions The UK prevalence and incidence of clinically significant CPE is currently low, but these MDR bacteria affect most UK regions. Improved IPC measures, vigilance and monitoring are required.


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