Authors (including presenting author) :
Wong YM (1), Mo CY (1), Tsen OW(1), Yip PN(1), Lai WMY(1), Wong YCA(1), Chow SH(1), Chow LL (1), Wong LHP(1), Mui ML(1), Wong WM(1)
Affiliation :
(1)Infection Control Team, Hong Kong East Cluster
Introduction :
Increasing prevalence on Carbapenemase-producing Enterobacteriaceae (CPE) poses urgent threats around the world and locally. Contact precautions and single room isolation are advised for patients with confirmed CPE. However, it is controversial on the date on CPE clearance because patients can be colonized by CPE for long periods of time. Appropriate time for initiate clearance screening after CPE confirmation is not mentioned in the HA guideline.
Objectives :
1. To identify the risk factors for prolonged CPE carriage in Hong Kong East Cluster (HKEC)
2. To explore the appropriate time for performing CPE clearance screening tests
Methodology :
A case-control study was conducted. All patients with first confirmation with CPE from rectal swab/stool from 2015 to 30 June 2018 were reviewed retrospectively. Known CPE cases with documented clearance of CPE carriage were classified as the “control” whereas patients who did not have any subsequent screenings or remained CPE positive in the subsequent screening were counted as “case”.
Result & Outcome :
A total of 61 patients confirmed with CPE were recruited. 18 patients (29.5%) were classified as “case” whereas 43 patients (70.5%) as “control”. A univariate analysis demonstrated antibiotic consumption was significantly associated with CPE carriage (94.4%, p= 0.028) and is also one of the known risk factors for CPE. The activity of daily living (ADL) also played a significant role in the CPE carriage in some studies. However, data showed CPE cases with low functional status were found to be favored with CPE clearance. It could be postulated that these cases were more dependent to healthcare service with frequent hospitalization. Hence active clearance screenings were able to be performed and resulted in a higher chance to fulfill clearance criteria. 42.9% of CPE cases performed CPE clearance screening and found to be relapsed in the later days. Hence, early initiation of clearance screening might contribute to higher possibility for CPE relapse. The most favorable CPE clearance screening should be initiated at least 76 days after CPE confirmation to minimize risk of transmission from possible relapse cases.The limitation of this study was the small sample size which may hinder the validity and generalizability of the result. Lager scale study to identify appropriate time for CPE clearance screening and applicable to corporate-wide is recommended.
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