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. 2024 Apr 26;24(1):444.
doi: 10.1186/s12879-024-09307-y.

A practical approach to screening for carbapenemase-producing Enterobacterales- views of a group of multidisciplinary experts from English hospitals

D R Jenkins  1 , C Auckland  2 , C Chadwick  3 , A R Dodgson  4 , D A Enoch  5 , S D Goldenberg  6 , A Hussain  7 , J Martin  8 , E Spooner  9 , T Whalley  10
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A practical approach to screening for carbapenemase-producing Enterobacterales- views of a group of multidisciplinary experts from English hospitals

D R Jenkins et al. BMC Infect Dis. .

Abstract

Introduction: Carbapenemase-producing Enterobacterales (CPE) are an important public health threat, with costly operational and economic consequences for NHS Integrated Care Systems and NHS Trusts. UK Health Security Agency guidelines recommend that Trusts use locally developed risk assessments to accurately identify high-risk individuals for screening, and implement the most appropriate method of testing, but this presents many challenges.

Methods: A convenience sample of cross-specialty experts from across England met to discuss the barriers and practical solutions to implementing UK Health Security Agency framework into operational and clinical workflows. The group derived responses to six key questions that are frequently asked about screening for CPE.

Key findings: Four patient groups were identified for CPE screening: high-risk unplanned admissions, high-risk elective admissions, patients in high-risk units, and known positive contacts. Rapid molecular testing is a preferred screening method for some of these settings, offering faster turnaround times and more accurate results than culture-based testing. It is important to stimulate action now, as several lessons can be learnt from screening during the COVID-19 pandemic, as well as from CPE outbreaks.

Conclusion: Further decisive and instructive information is needed to establish CPE screening protocols based on local epidemiology and risk factors. Local management should continually evaluate local epidemiology, analysing data and undertaking frequent prevalence studies to understand risks, and prepare resources- such as upscaled screening- to prevent increasing prevalence, clusters or outbreaks. Rapid molecular-based methods will be a crucial part of these considerations, as they can reduce unnecessary isolation and opportunity costs.

Keywords: Antimicrobial resistance; Carbapenemase-producing enterobacterales; Guidance; Healthcare legislation; Public health; Roundtable meeting.

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Conflict of interest statement

All authors received honoraria from Cepheid for attending the round table. David Jenkins reports receiving speaker fees from Cepheid and Pfizer, and advisory board fees from Shionogi.David Enoch reports receiving a travel grant from Becton Dickinson and advisory board fees from Napp. Simon Goldenberg reports receiving consulting fees from Astra Zeneca, Tillotts, and EnteroBiotix, speaker fees from Tillotts and holds stock in iFast Diagnostics Ltd. Jessica Martin reports receiving honoraria from Gilead, Shionogi, Tillotts and Pfizer. Terry Whalley reports receiving consulting fees from Cepheid.All other authors report no competing interests.

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