06/01/2016 1 ESBL and CPE: Mutants, Migrants and Masterminds Debbie Demizio BA RRT CIC IPAC-EO Education Day June 3, 2016 Image source: CDC PublicHealthOntario.ca Objectives MUTANTS • Describe the characteristics of ESBL and CPE • Compare the threat of ESBL and CPE MIGRANTS • Identify the risk factors • Consider travel as a risk factor MASTERMINDS • Identify infection control measures • State the criteria to discontinue contact precautions • Select the appropriate tests for surveillance • Be aware of the important role of antibiotic stewardship 2 PublicHealthOntario.ca How antimicrobial resistance occurs 3 Image source: Public Health Ontario
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06/01/2016
1
ESBL and CPE: Mutants,
Migrants and Masterminds
Debbie Demizio BA RRT CIC
IPAC-EO Education Day
June 3, 2016
Image source: CDC
PublicHealthOntario.ca
Objectives
MUTANTS
• Describe the characteristics of ESBL and CPE
• Compare the threat of ESBL and CPE
MIGRANTS
• Identify the risk factors
• Consider travel as a risk factor
MASTERMINDS
• Identify infection control measures
• State the criteria to discontinue contact precautions
• Select the appropriate tests for surveillance
• Be aware of the important role of antibiotic stewardship
Positive for CPE? Has the patient received health care in another country in the previous 12 months? Is the patient a direct transfer from another healthcare facility outside Canada?
Birgand G, Armand-Lefebvre L, Lolom I, Ruppe E, Andremont A, Lucet JC. Duration of colonization of extended-spectrum beta-lactamase producing enterobacteriaceae after hospital discharge. American Journal of Infection Control. 2013; 41: 443-7.
Boucher HW et al. Bad drugs, no drugs: No ESKAPE! Clin. Infect. Dis.2009; 48(1): 1-12.
Centers for Disease Control. CPE guidance for control of CPE. C2012. Available from http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf
Centers for Disease Control. 2013. Antibiotic resistance threats within the United States. Available from http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf
Centers for Disease Control. Get smart for healthcare: Inpatient stewardship. Available from http://www.cdc.gov/getsmart/healthcare/inpatient-stewardship.html#Facts
Centers for Disease Control. Vital signs. C2013. Available from http://www.cdc.gov/vitalsigns/HAI/CRE/infographic.html
Conly J. Antimicrobial resistance in Canada. CMAJ 2002; 167(8): 885-91.
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References – con’t Conly J, Pitout J, Dalton B, Sabuda D. National Collaborating Centre for Infectious Diseases. The
W-5 of NDM-1: the pinnacle of antimicrobial resistance. Nov 2011. Available from http://www.nccid.ca/files/Purple_Paper_Note_mauve/PP_33_EN.pdf
Johnson SW, Anderson DJ, May DB, Drew RH. Utility of a clinical risk factor scoring model in predicting infection with ESBL-producing Enterobacteriaceae on hospital admission. ICHE, April 2013
Paltansing S, Vlot A, Kraakman MEM, Mesman R, et al. Extended-Spectrum β-Lactamase producing Enterobacteriaceae among travellers in the Netherlands. Emerging Infectious Diseases. 2013; 19:8. Available from http://wwwnc.cdc.gov/eid/article/19/8/13-0257_intro.htm
Parker VA, Logan CK, Currie B. Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit. (Prepared by Boston University School of Public Health and Montefiore Medical Center under Contract No. 290-2006-0012-l.) AHRQ Publication No. 14-0028. Rockville, MD: Agency for Healthcare Research and Quality. April 2014. Available from http://www.ahrq.gov/sites/default/files/publications/files/cretoolkit.pdf
Patrick DM, Hutchinson J. Antibiotic use and population ecology: How you can reduce your
producing Gram negatives in Alberta, Canada: the first three years. 2014. J. Clin. Microbiol.
PIDAC. Routine Practices and Additional Precautions, Annex A, Feb 2012. Available from http://www.oahpp.ca/resources/documents/pidac/Annex%20A%20-%20PHO%20template%20-%20REVISION%20-%202012Apr25.pdf
Public Health England. Acute trust toolkit for the early detection, management and control of
Carbapenemase-producing Enterobacteriaceae. 2013. Available from
Public Health Ontario. Quarterly CPE surveillance report, April 2016. Available from http://www.publichealthontario.ca/en/DataAndAnalytics/Documents/Carbapenemase_Producing_Enterobacteriaceae_(CPE)_Surveillance_Report_April_2016.pdf
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References – con’t
Tangden T, Cars O, Melhus A, Lowdin E. 2010. Foreign travel is a major risk factor for colonization
with Escherichia coli producing CTX-M type Extended-Spectrum β-Lactamases: a prospective
study with Swedish volunteers. Antimicrobial Agents and Chemotherapy; 54:9;3564-3568.
Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the
New Delhi environment and its implications on human health. The Lancet Infect. Dis. 2011;
11(5): 355-62.
Zimmerman RS, Assous MV, Bdolah-Abram T, Lachish T, Yinnom AN, Wiener-Well Y. Duration of
carriage of carbapenem-resistant Enterobacteriaceae following hospital carriage. AJIC 2013;