Risk factors for patients with carbapenemaseproducing Enterobacteriaceae CPE

Risk factors for patients with carbapenemaseproducing Enterobacteriaceae (CPE) at Imperial College Healthcare NHS Trust, 2014 – 2015 Siddharth Mookerjee, Jonathan Sullivan, Frances Davies, Hugo Donaldson, Eimear Brannigan, Alison Holmes, Jonathan Otter Jon. Otter@imperial. nhs. uk

What’s this talk about? • Introduction – Let’s talk CPE!! – European picture • Methods: What we did at Imperial – Live surveillance – Analysis • Summary – What did we learn?

What are CPEs? Anyone? • C – Carbapenemase • P – Producing • E – Enterobacteriaceae CPO! CRE! CRO? ! Why do they pose a threat? • Key resistance mechanisms acquired – HGT • Establish community reservoir – asymptomatic carriage • Prior hospital stay – key risk factor • Large at-risk group

European picture ECDC

Methods: What we did at Imperial Live surveillance system established in May 2014 56 positive CPO isolates (May 14 – Mar 15) 43 patients Enterobacteriaceae Non – fermenters 38 isolates 18 isolates 28 patients 15 patients

PHE reference no VNTR Isolate Molecular mechanism DOB Gender Patient name Ethnicity Sample type Patient hospital number Ward location where specimen taken Specimen collection date Lab number for specimen Previous hospitalisation within UK/abroad Travel abroad Co-morbidities, hospital diagnosis High dependency care history

Distribution of CPO Other 34% K. pneumoniae OXA-48 39% K. pneumoniae NDM 27%

Distribution of CPE by isolate and mechanism of resistance

Comparison of risk factors – Enterobacteriaceae vs. Non-fermenters Detailed risk factor data was not available for all patients.

K. pneumoniae NDM outbreak 35 Count of Kleb NDM cases 10 8 Cumulative 8 30 7 6 25 3 15 10 5 Equals an Epi curve going in the right direction! Aug-15 Jul-15 Jun-15 May-15 0 Apr-15 0 Mar-15 0 Feb-15 2 Jan-15 0 1 Dec-14 0 Nov-14 0 Oct-14 0 0 Sep-14 1 Aug-14 4 2 20 5 Jul-14 Count of cases 40 11 Cumulative count of cases 12

Summary: What did we learn? • CPE are emerging at ICHT • We experienced a clonal outbreak in the background of sporadic cases • Sporadic cases have the ‘classic’ CPE risk factors (related to overseas travel etc), which do not seem to be shared by non-fermenters • Real-time surveillance proved used in detecting and tracking the outbreak and wider CPE picture at ICHT

Imperial researchers at IPS Oral presentations Abstract ID: 3865 - Otter J, Dyakova E, Bisnauthsing K, Querol-Rubiera A, Girdham S, Patel A, Ahanonu C, Tosas Auguet O, Edgeworth J, Goldenberg S. Who’s carrying CRE? Universal admission screening in London Abstract ID: 3866 - Dyakova E, Bisnauthsing K, Querol-Rubiera A, Girdham S, Patel A, Ahanonu C, Tosas Auguet O, Edgeworth J, Goldenberg S, Otter J. “Can I swab your rectum, please? ”: Improving compliance with rectal screening for CRE Abstract ID: 3860 - Mookerjee S, Sullivan J, Davies F, Donaldson H, Brannigan E, Holmes A, Otter J. Risk factors for patients with carbapenemase-producing Enterobacteriaceae (CPE) in a Northwest London hospital Trust, 2014 – 2015 Posters Abstract ID: 3785 - Ahmad R, Castro-Sanchez E, Iwami M, Husson F, Holmes A. Knowledge, perceptions and decision making: What matters to patients? Abstract ID: 3798 - Record C, Gilchrist M, Patel D, Jiao L. Infection prevention in splenectomy patients: An audit of practice in a regional hepatobiliary centre Abstract ID: 3799 - Turnbull A, Moore L, Azadian B. To PPE or not to PPE Abstract ID: 3858 - Batten L, Holmes A, Otter J, Castro-Sanchez E. Estimating the isolation burden if overseas residents are pre-emptively isolated during CRE admission screening Abstract ID: 3859 - Mookerjee S, Sullivan J, Davies F, Donaldson H, Brannigan E, Holmes A, Otter J. Real-time surveillance of carbapenem-resistant Enterobacteriaceae (CRE) using live microbiology culture data in a North-West London Hospital Trust, 2014– 2015 Abstract ID: 3861 - Alexander M, Mookerjee S, Nelson D, Holmes A, Otter J. An audit of single room capacity for isolation at a London hospital Trust Abstract ID: 3862 - Galletly T, Bateman A, Brannigan E, Holmes A, Otter J. Thematic analysis of post 48 -hour bloodstream infections: What did we learn? Abstract ID: 3863 - Acharya A , Samarasinghe D , Singleton J, Brannigan E, Galletly T, Donaldson H, Holmes A, Otter J. Pilot evaluation of environmental hygiene using fluorescent markers and microbiological cultures Abstract ID: 3864 - Gilchrist M , Galletly T, Brannigan E, Holmes A, Otter J. How much Clostridium difficile is preventable? Abstract ID: 3867 - Goldberg S, Dyakova E, Bisnauthsing K, Querol-Rubiera A, Girdham S, Patel A, Ahanonu C, Tosas Auguet O, Edgeworth J, Otter J. Poor sensitivity of perineal compared with rectal swabs for detecting ESBL Enterobacteriaceae

Risk factors for patients with carbapenemaseproducing Enterobacteriaceae (CPE) at Imperial College Healthcare NHS Trust, 2014 – 2015 Siddharth Mookerjee, Jonathan Sullivan, Frances Davies, Hugo Donaldson, Eimear Brannigan, Alison Holmes, Jonathan Otter Jon. Otter@imperial. nhs. uk jonotter. net