Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Aug 13:8:136.
doi: 10.1186/s13756-019-0591-6. eCollection 2019.

Screening for carriage of carbapenem-resistant Enterobacteriaceae in settings of high endemicity: a position paper from an Italian working group on CRE infections

Simone Ambretti  1 , Matteo Bassetti  2 , Pierangelo Clerici  3 , Nicola Petrosillo  4 , Fabio Tumietto  5 , Pierluigi Viale  5 , Gian Maria Rossolini  6
Affiliations
Review

Screening for carriage of carbapenem-resistant Enterobacteriaceae in settings of high endemicity: a position paper from an Italian working group on CRE infections

Simone Ambretti et al. Antimicrob Resist Infect Control. .

Abstract

Introduction: A variety of national and international guidelines exist around the management of carbapenem resistant Enterobacteriaceae (CREs), but some of these are several years old and do not reflect current epidemiology and they also do not necessarily give pragmatic advice around active surveillance of CREs in countries with a high burden of cases and limited resources. This paper aims to provide a best practice position paper to guide active surveillance in a variety of scenarios in these settings, and discusses which patients should be screened, what methods could be used for screening, and how results might influence infection prevention interventions.

Methods: This paper was developed as a result of a series of meetings of expert opinion leaders representing the major infectious disease and infection prevention societies in Italy and having the endorsement of AMCLI (Italian Association of Clinical Microbiology) and SITA (Italian Society for Anti-infective Therapy). There was no attempt to undertake a full systematic review of the evidence, as it was felt that this was inadequate to inform a pragmatic view on the best way forward based on current epidemiology and infection rates.

Key recommendations: Key recommendations focus on the urgent need to promote measures to prevent transmission and infection, focusing on high risk patients and clinical areas, as well as outbreak situations. Active surveillance leading to appropriate infection prevention precautions plays a major role in this.

Conclusions: There are limited national or international guidelines giving pragmatic advice on the most appropriate measures for active surveillance and management of colonized patients in a high-burden setting such as Italy. While individual hospitals and regions will need to formulate their own policies based on local epidemiology, this position paper attempts to highlight current best practice in this area and provide pragmatic advice for clinicians, infection prevention staff, and healthcare managers.

Keywords: Active surveillance; Carbapenem-resistant; Enterobacteriaceae; Infection control.

PubMed Disclaimer

Conflict of interest statement

Competing interestsFor activities outside of the submitted work, SA has received fees as speaker from ADA, Biomerieux, Cepheid, MB has received funding for scientific advisory boards, travel and speaker honoraria from Angelini, Astellas Pharma, AstraZeneca, Bayer, Biomerieux, Cepheid, Cidara, Pfizer, Menarini, MSD, Nabriva, Paratek, Roche, Shionogi, Tetraphase, Thermofisher and the Medicine Company, NP has received fees as speaker from MSD, Pfizer, Cepheid, Takeda, Shionogi, Angelini, Zambon, Becton & Dickinson, Johnson & Johnson, PV has served as a consultant for MSD, PFIZER, VENATORX, NABRIVA, GILEAD, THERMOFISHER and BIOMERIEUX and received payment for serving on the speaker’s bureau for MSD, PFIZER, CORREVIO and GILEAD, GMR has received honoraria for scientific advisory boards, travel and speaker’s bureau from Accelerate, Angelini, AstraZeneca, Basilea, Beckman Coulter, Biotest, Cepheid, Curetis, Elitech, Menarini, Merck, Nordic Pharma, Novartis, Pfizer, Qpex, Rempex, Roche, Thermo Fisher, VenatorX, Zambon; and research grants to the laboratory from from Accelerate, Alifax, Angelini, Arrow, AstraZeneca, Basilea, Becton-Dickinson, bioMérieux, Biotest, Cepheid, Checkpoints, Elitech, Estor, Liofilchem, Menarini, Merck, Nordic Pharma, Novartis, Pfizer, Rempex, Seegene, Shionogi, VenatorX, Zambon. PC and FT declare that they have no competing interests.

References

    1. Logan Latania K., Weinstein Robert A. The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace. The Journal of Infectious Diseases. 2017;215(suppl_1):S28–S36. doi: 10.1093/infdis/jiw282. - DOI - PMC - PubMed
    1. Goodman KE, Simner PJ, Tamma PD, Milstone AM. Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant Enterobacteriaceae (CRE) Expert Rev Anti Infect Ther. 2016;14(1):95–108. doi: 10.1586/14787210.2016.1106940. - DOI - PubMed
    1. Temkin E, Adler A, Lerner A, Carmeli Y. Carbapenem-resistant Enterobacteriaceae: biology, epidemiology, and management. Ann N Y Acad Sci. 2014;1323:22–42. doi: 10.1111/nyas.12537. - DOI - PubMed
    1. ECDC . EARS-NET report. 2017.
    1. Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT, Andrasević AT, Cantón R, Carmeli Y, Friedrich AW, Giske CG, Glupczynski Y, Gniadkowski M, Livermore DM, Nordmann P, Poirel L, Rossolini GM, Seifert H, Vatopoulos A, Walsh T, Woodford N, Monnet DL. European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) Working Group. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis. 2017;17:153–163. doi: 10.1016/S1473-3099(16)30257-2. - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources