The role of screening in hospital outbreaks of Extended Spectrum Beta-Lactamase (ESBL) producing Klebsiella pneumoniae (KP)
PHE ePoster Library. Gardiner D. Apr 10, 2019; 259611; 15588
Daniel Gardiner
Daniel Gardiner
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Abstract We examine the role of screening in the largest documented UK hospital outbreak of Extended Spectrum Beta-Lactamase (ESBL) producing Klebsiella pneumoniae (KP)The outbreak was first recognised when two clinical cases were detected on one ward at the end of March 2018. Infection prevention and control (IPC) measures, including screening of all ward contacts (rectal, urine and wounds). were agreed at the first OCT in April. In May 2018 screening for repeat admissions (since the beginning of the outbreak) was introduced. Screening was stopped on wards with no new positives for three consecutive weeks.A review of ESBL KP isolates with specific antibiogram (+/- VNTR profile) reported by the hospital found that the number of patients with the outbreak strain increased in October 2017. During the outbreak 28,683 screening samples were taken from 12,752 patients, 262 patients had the outbreak strain (10 blood, 59 urine 166 stool, 25 other and 2 unknown). All were considered to be hospital acquired, as this was a unique strain identified in the UK and all had an admission to that hospital since October 2017. Although community screening was not undertaken, we had no evidence of community transmission.The outbreak was declared over in November 2018.Screening allowed recognition of the extent of the outbreak and demonstrated ongoing hospital transmission. This prompted rigorous implementation of IPC measures across the hospital. However, screening was resource intensive and required a significant input from staff, diverting efforts from other duties. Limitations included the uncertain epidemiology (incubation period, infectious period, time from colonisation to infection or clearance, baseline prevalence of colonisation) and difficulty in identifying newly hospital acquired cases as opposed to colonisation from a previous admission.Despite large resource implications and uncertain epidemiology, widespread screening is an important part of outbreak identification and control for MDR Gram negatives.
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