Information for Wards regarding KPC carbepenemase producers
What are they :
These are bacteria (usually E.coli or Klebsiella pneumoniae) which are normally
found in the GI tract. In colonized patients the bacteria have acquired a set of
genes that make them resistant to multiple antibiotics. The most concerning is
resistance to the carbepenems (meropenem, ertapenem etc) which we use for
serious gram –ve infections as organisms are almost always sensitive to these
antibiotics. They are resistant to all penicillins and combination penicillins (coamoxiclav/ tazocin). They are usually sensitive to tigecycline and gentamicin and
may also be sensitive to ciprofloxacin. There are rare cases where these
organisms have become resistant to almost all antibiotics currently in use.
Where have the come from :
KPC strains are known to be a problem in the US, India, China and elsewhere.
These organisms are slowly becoming endemic in the North West region over
the past 2 years but are rare in the rest of the UK. It is not known how they
entered the hospital environment originally. Patients in Stepping Hill will have
acquired the organism while admitted to one of the other hospitals in the region.
So far we have not had any new cases acquired at this hospital.
Infection Prevention :
These organisms will be part of the bacterial flora colonising the patients GI tract.
They can also colonise the urinary tract, especially in patients with catheters or
abnormalities of the urinary tract. These bacteria do not survive well in the
environment.
PPE when attending to the patient is important. Care should be taken when
handling urine/ faeces or equipment contaminated by these bodily fluids.
Standard cleaning of the patient environment and contaminated equipment is
sufficient as these organisms do not survive long in the external setting.
The patient should be isolated and ideally have their own toilet/showering
facilities. Cross infection is most likely to be due to contamination of the hands of
staff or relatives. Staff or relatives can carry the bacteria to other patients who
then become colonized, if handwashing is poor. Good hand hygiene and use of
PPE are therefore critical in stopping the spread of these organisms. Alcohol gel
is active against these organisms.
At present we don’t know if patients become decolonised over time. We treat
them as colonised for their whole admission and any future admissions. Patients
carrying this organism are one of our highest priorities for isolation, the other
being active C.difficile disease.
Patients are screened by rectal swabs. At present we only screen if a patient has
been in prolonged contact with another colonized patient.
Disease :
Most patients are colonised but have no symptoms. Some patients will present
with urinary tract infections, which will be difficult to treat as the organism is
usually resistant to oral options and the majority of iv options. The organism can
also be a problem if patients have intra-abdominal sepsis or require abdominal
surgery. Intravascular line sepsis has also occurred with these organisms. The
other vulnerable group of patients are the immunosuppressed. In all these cases
antibiotic choice will be severely limited and sub-optimal. These organisms can
also colonise wounds and ulcers but should not be a problem with intact skin.
Important points :
This is a new emerging problem so infection control is vital. So far we have had
NO in-hospital spread at Stepping Hill Hospital. However these organisms can
become endemic and spread throughout a hospital, as has happened in other
parts of the region. It is vitally important therefore to adhere to use of PPE and
good cleaning of all contaminated equipment. The organism is easily removed
from surfaces and does not survive well in the external environment. It is staff
and relatives who are the main risk for transferring these organisms to other
patients, mainly on their hands. Alcohol gel is adequate for unsoiled
handwashing.
Treatment options are severely limited and sub-optimal for any patient who
develops infection with these organisms. Therefore our best defence is
PREVENTION of cross-infection.
We have no idea if patients ever become decolonised and there is no
straightforward way to attempt decolonization. Patients are therefore considered
to be colonized for the whole of their current admission and any future
admissions.
Further Information
For further information please contact either the Microbiology Department
(xt.4491) or the Infection Prevention Team (xt.4669)
Alternatively the authors of this information sheet can be contacted by email :
Dr. D Scarr (Microbiology ST2) : dominic.scarr@stockport.nhs.uk
Dr. S. Maxwell (Consultant Microbiologist) : sarah.maxwell@stockport.nhs.uk
Dr. Moira Taylor (Consultant Microbiologist) : moira.taylor@stockport.nhs.uk