The following collection was assembled as a contribution to an Infection Prevention bulletin produced on behalf of the West Midlands Current Awareness Group in March 2014.
There have been 600 reported cases of antibiotic-resistant bacteria called Carbapenemase-producing Enterobacteriaceae (CPE) in England during the past year. These bacteria have developed resistance against carbapenems, the antibiotics which are usually used to treat serious infections. Drug-resistant CPE bacteria produce an enzyme (carbapenemase) which breaks down the antibiotic and makes it ineffective. The drug-resistant superbug called Klebsiella pneumoniae Carbapenemase (KPC) is noteworthy.
Only five patients were reported to Public Health England as having CPE in 2006; by 2013 this number exceeded 600. This number includes people who may only be carriers of CPE, and those with more serious infections. Public Health England has produced information leaflets for healthcare professionals to hand to people identified as being carriers or infected with CPE, and for people in contact with infected patients.
Public Health England has released a “toolkit” to address the problem of increasing outbreaks of hospital infections caused by antibiotic-resistant bacteria across England. This set of recommendations has been designed to provide plans and procedures to help health staff limit the spread of CPE in hospitals and into the community.
The toolkit focuses on the early detection of CPE. It offers advice on how to manage or treat CPE, and to control the spread of CPE in hospitals and residential care homes.
Antibiotic resistance ‘toolkit’ launched. London: NHS Choices Behind the Headlines, March 7th 2013.
This relates to:
PHE launches toolkit to manage hospital infections caused by antibiotic-resistant bacteria. London: Public Health England, March 6th 2014.
The Public Health England Toolkit
Public Health England’s toolkit offering guidance for hospitals on the detection, management and control antibiotic-resistant bacterial infections caused by CPE may be accessed here:
Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae. London: Public Health England, December 2013.
NHS England Patient Safety Alert
NHS England has issued a (Level 2) patient safety alert about addressing the rising outbreaks of carbapenemase-producing Enterobacteriaceae:
Patient safety alert on addressing rising trends and outbreaks in carbapenemase-producing Enterobacteriaceae. London: NHS England, March 6th 2014.
The Broader Policy Context
Volume Two of the Chief Medical Officer, Professor Dame Sally Davies’s first annual epidemiology and surveillance report made several recommendations on antimicrobial resistance.
Professor Dame Sally Davies (2013). Annual report of the Chief Medical Officer: Volume Two, 2011. Infections and the rise of antimicrobial resistance. London: Department of Health, March 2013.
The Advisory Committee on Antimicrobial and Healthcare Associated Infections (ARHAI)’s fourth annual report includes ARHAI’s work plan for 2013 to 2014:
Wallace, J. (2013). Advisory committee on antimicrobial resistance and healthcare associated infections: 4th Annual Report, February 2012 – March 2013. London: Department of Health / Public Health England, November 12th 2013.
A cross-government UK strategy was announced last year to slow the development and spread of antimicrobial resistance. It has three strategic aims:
- Improving knowledge and understanding of antimicrobial resistance.
- Conservation and stewardship of the effectiveness of existing treatments.
- Stimulating the development of new antibiotics, diagnostics and novel therapies.
UK five-year Antimicrobial Resistance Strategy 2013 to 2018. London: Department of Health, September 10th 2013.
Public Health England Surveillance
Carbapenem resistance. London [Online]: Public Health England, December 2013.
Possible also of interest, there is:
The British Society for Antimicrobial Chemotherapy’s Bacteraemia Resistance Surveillance Programme. [Online]: British Society for Antimicrobial Chemotherapy (BSAC) Resistance Surveillance Project, 2014.
Canadian Guidelines on Infection Prevention and Control Procedures for Carbapenemase-Producing Enterobacteriaceae (CADTH)
The Canadian Agency for Drugs and Technologies in Health (CADTH) has produced a carbapenemase-producing Enterobacteriaceae summary, which examines the effectiveness of screening procedures, interventions to prevent transmission, contact management and the evidence-based guidelines available.
Infection prevention and control procedures for carbapenemase-producing enterobacteriaceae: clinical effectiveness and guidelines. [Online: Canada]: Canadian Agency for Drugs and Technologies in Health (CADTH), August 13th 2014.
Recent Reviews and Other Articles
Laxminarayan, R. Duse, A. Wattal, C. [et al] (2013). Antibiotic resistance: the need for global solutions. Lancet Infectious Disorders. December 2013; 13(12): 1057-98.
Nordmann, P. Dortet, L. Poirel, L. (2012). Carbapenem resistance in Enterobacteriaceae: here is the storm! Trends in Molecular Medicine. May 2012; 18(5): 263-72. Review.
Gupta, N. Limbago, BM. Patel, JB. [et al]. (2011). Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clinical Infectious Diseases. July 1st 2011; 53(1): 60-7. Full Text Link.
Nordmann, P. (2014). Carbapenemase-producing enterobacteriaceae: overview of a major public health challenge. Medecine et Maladies Infectieuses. February 2014; 44(2): 51-56. Review.
Tzouvelekis, LS. Markogiannakis, A. Psichogiou, M. [et al] (2012). Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clinical Microbiology Reviews. October 2012; 25(4): 682-707. Full Text Link.
Munoz-Price, LS. Poirel, L. Bonomo, RA. [et al] (2013). Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infectious Disorders. September 2013; 13(9): 785-96. Review.
Kothari, C. Gaind, R. Singh, LC. [et al] (2014). Community acquisition of β-lactamase producing Enterobacteriaceae in neonatal gut. BMC Microbiology. June 17th 2013; 13: 136. Full Text Link.
Ramos, PI. Picão, RC. Almeida, LG. [et al] (2014). Comparative analysis of the complete genome of KPC-2-producing Klebsiella pneumoniae Kp13 reveals remarkable genome plasticity and a wide repertoire of virulence and resistance mechanisms. BMC Genomics. January 22nd 2014; 15: 54. Full Text Link.
Carbonne, A. Thiolet, JM. Fournier, S. [et al] (2010). Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveillance: European Communicable Disease Bulletin. December 2nd 2010; 15(48). Full Text Link.
Alrabaa, SF. Nguyen, P. Sanderson, R. [et al] (2013). Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. American Journal of Infection Control. June 2013; 41(6): 562-4.
Jain, R. Walk, ST. Aronoff, DM. [et al] (2013). Emergence of Carbapenemase producing Klebsiella Pneumoniae of Sequence type 258 in Michigan, USA. Infectious Disease Reports. January 22nd 2013; 5(1): e5. Review. Full Text Link.
Arnold, RS. Thom, KA. Sharma, S. [et al] (2011). Emergence of Klebsiella pneumoniae carbapenemase-producing bacteria. Southern Medical Journal. January 2011; 104(1): 40-5. Review. Full Text Link.
Giani, T. Pini, B. Arena, F. [et al] (2013). Epidemic diffusion of KPC carbapenemase-producing Klebsiella pneumoniae in Italy: results of the first countrywide survey, 15 May to 30 June 2011. Euro Surveillance: European Communicable Disease Bulletin. May 30th 2013; 18(22). Full Text Link.
Bracco, S. Migliavacca, R. Pini, B. [et al] (2013). Evaluation of brilliance CRE agar for the detection of carbapenem-resistant gram-negative bacteria. New Microbiologica. April 2013; 36(2): 181-6. Full Text Link.
Nordmann, P. Gniadkowski, M. Giske, CG. [et al] (2012). Identification and screening of carbapenemase-producing Enterobacteriaceae. Clinical Microbiology and Infection. May 2012; 18(5): 432-Review. Full Text Link.
Picão, RC. Jones, RN. Mendes, RE. [et al] (2014). Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae testing susceptible to cefepime by reference methods. Journal of Clinical Microbiology. July 2013; 51(7): 2388-90. Full Text Link.
Rapp, RP. Urban, C. (2012). Klebsiella pneumoniae carbapenemases in Enterobacteriaceae: history, evolution, and microbiology concerns. Pharmacotherapy. May 2012; 32(5): 399-407.
Di Carlo, P. Gulotta, G. Casuccio, A. [et al] (2014). KPC – 3 Klebsiella pneumoniae ST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients. BMC Anesthesiology. July 3rd 2013; 13(1): 13. Full Text Link.
Tofteland, S. Naseer, U. Lislevand, JH. [et al] (2013). A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One. 2013; 8(3): e59015. Full Text Link.
Lee, GC. Burgess, DS. (2013). Polymyxins and Doripenem combination against KPC-producing Klebsiella pneumoniae. Journal of Clinical Medicine Research. April 2013; 5(2): 97-100. Full Text Link.
Sandora, TJ. Goldmann, DA. (2012). Preventing lethal hospital outbreaks of antibiotic-resistant bacteria. The New England Journal of Medicine. December 6th 2012; 367(23): 2168-70. Full Text Link.
Cantón, R. Akóva, M. Carmeli, Y. [et al]; European Network on Carbapenemases (2012). Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clinical Microbiology and Infection. May 2012;18(5): 413-31. Full Text Link.
van der Bij, AK. Pitout, JD. (2012). The role of international travel in the worldwide spread of multiresistant Enterobacteriaceae. Journal of Antimicrobial Chemotherapy. September 2012; 67(9): 2090-100. Review. Full Text Link.
Gaibani, P. Colombo, R. Arghittu, M. [et al] (2014). Successful containment and infection control of a Carbapenem-resistant Klebsiella pneumoniae outbreak in an Italian hospital. New Microbiology. January 2014; 37(1): 87-90. Full Text Link.
Ceccarelli, G. Falcone, M. Giordano, A. [et al] (2013). Successful ertapenem-doripenem combination treatment of bacteremic ventilator-associated pneumonia due to colistin-resistant KPC-producing Klebsiella pneumoniae. Antimicrobial Agents and Chemotherapy. June 2013; 57(6): 2900-1. Full Text Link.
Falagas, ME. Karageorgopoulos, DE. Nordmann, P. [et al] (2011). Therapeutic options for infections with Enterobacteriaceae producing carbapenem-hydrolyzing enzymes. Future Microbiology. June 2011; 6(6): 653-66. Review.
Du, X. Fu, Y. Yu, Y. (2013). Tigecycline treatment of infection caused by KPC-producing Escherichia coli in a pediatric patient. Annals of Clinical Microbiology and Antimicrobials. August 13th 2013; 12: 19. Full Text Link.
Lee, GC. Burgess, DS. (2012). Treatment of Klebsiella pneumoniae carbapenemase (KPC) infections: a review of published case series and case reports. Annals of Clinical Microbiology and Antimicrobials. December 13th 2012; 11: 32. Full Text Link.
Patel, G. Bonomo, RA. (2013). “Stormy waters ahead”: global emergence of carbapenemases. Frontiers in Microbiology. March 2013; 4: 48. Full Text Link.
Tascini, C. Tagliaferri, E. Giani, T. [et al] (2014). Synergistic activity of colistin plus rifampin against colistin-resistant KPC-producing Klebsiella pneumoniae. Antimicrobial Agents and Chemotherapy. August 2013; 57(8): 3990-3. Full Text Link.