Contagious Connections – Tracing the Threads of Infection Transmission of carbapenemase-producing Enterobacterales amongst Close Contact Patients
Denise Del Rosario-Kelly1, Megan Gritt1, Pauline Bass1, Andrew Stewardson11Alfred Health, Melbourne, Victoria, Australia
Introduction
Carbapenemase-producing Enterobacterales (CPE) pose a significant threat to public health. In Victoria, CPE was designated as a notifiable condition in 2015, with accompanying comprehensive management guidelines from the Victorian Department of Health. These guidelines emphasised screening close contacts of newly-identified CPE patients, as crucial for transmission control. We assessed the rate of positive screening results amongst close contacts in our service.
Methods
Data from a dedicated CPE database within the Infection Prevention department, spanning 2016-2023 was reviewed, encompassing index case information, close contacts, and screening outcomes. Index cases were classified as patients who tested positive for CPE whilst hospitalised, without direct epidemiologic connection to pre-existing CPE patients. Close contacts were patients who occupied adjacent cubicles in the Intensive Care Unit or the Burns Unit, or shared the same room or bathroom on a ward, with an index case for a minimum of 24 hours. Secondary index cases were close contacts who yielded positive CPE results in screening tests.
Results
We identified 414 index cases and 1892 corresponding close contacts. Amongst close contacts, 1121 (59.2%) underwent screening, including 225 exposed to IMP-4 producing Enterobacter cloacae ST93 and 355 exposed to IMP-4 producing Enterobacter cloacae ST190. Thirty-three secondary index cases (2.94%) were identified, with 17 (1.51%) sharing the same CPE genotype as their initial index case exposure.
Conclusion
Close contact CPE acquisition rate was low. Additional retrospective investigation is warranted to examine the epidemiology of CPE-positive patients, factors influencing CPE acquisition, and evaluate efficacy of current CPE transmission control strategies.
Biography
Denise has been at Alfred Health for almost 20 years and is a Senior Infection Prevention Nurse Consultant. She has a background in neuroscience nursing and infection control nursing, and has an interest in data analytics and outbreak management of multi-resistant organisms.
Megan is an Infection Prevention Nurse Consultant and Aseptic Technique Coordinator at Alfred Health. She has a background in Infectious Diseases and is working towards a Masters of Public Health and Tropical Medicine, with an interest in antimicrobial resistance and emerging public health threats.