Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures (2017)

Type of publication:
Journal article

Pascale Trepanier, Kim Mallard, Danièle Meunier, Rachel Pike, Derek Brown, Janet P. Ashby, Hugo Donaldson, F. Mustafa Awad-El-Kariem, Indran Balakrishnan, Marc Cubbon, Paul R. Chadwick, Michael Doughton, Rachael Doughton, Fiona Hardiman, *Graham Harvey, Carolyne Horner, John Lee, Jonathan Lewis, Anne Loughrey, Rohini Manuel, Helena Parsons, John D. Perry, Gemma Vanstone, Graham White, Nandini Shetty, John Coia, Camilla Wiuff, Katie L. Hopkins and Neil Woodford

Journal of Antimicrobial Chemotherapy, Feb 2017, vol. 72, no. 2, p.596-603

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.
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.
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%).
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.