Open Access Repository

Search and contain: Impact of an integrated genomic and epidemiological surveillance and response program for control of carbapenemase-producing Enterobacterales

Downloads

Downloads per month over past year

Lane, CR, Bret, J, Schultz, M, Gorrie, CL, Stevens, K, Cameron, DRM, St George, S, van Diemen, A, Easton, M, Stuart, RL, Sait, M, Peleg, AY, Stewardson, AJ, Cheng, AC, Spelman, DW, Waters, MJ, Ballard, SA, Sherry, NL, Williamson, DA, Romanes, F, Sutton, B, Kwong, JC, Seemann, T, Goncalves da Silva, A, Stephens, N ORCID: 0000-0002-7952-4581 and Howden, PJ 2020 , 'Search and contain: Impact of an integrated genomic and epidemiological surveillance and response program for control of carbapenemase-producing Enterobacterales' , Clinical Infectious Diseases , doi: 10.1093/cid/ciaa972.

[img]
Preview
PDF (Search and Contain: Impact of an integrated genomic and epidemiological surveillance and response program for control of carbapenemase-producing Enterobacterales)
Lane et al CID ...pdf | Download (855kB)

| Preview

Abstract

Background:Multi-resistant organisms (MROs) pose a critical threat to public health. Population-based programs for control of MROs such as Carbapenemase-producing Enterobacterales (CPE) have emerged and evaluation is needed. We assess the feasibility and impact of a state-wide CPE surveillance and response program deployed in December 2015 across Victoria, Australia (population 6.5 million).Methods:A prospective multi-modal intervention including active screening, carrier isolation, centralised case investigation and comparative pathogen genomics was implemented. We analyze trend in CPE incidence and clinical presentation, risk factors and local transmission over the program’s first three years (January 2016 to December 2018).Results:CPE case ascertainment increased over the study period to 1.42 cases/100,000 population, linked to increased screening without a concomitant rise in active clinical infections (0.45-0.60 infections/100,000 population, p=0.640). KPC-2 infection decreased from 0.29 infections/100,000 population prior to intervention to 0.03 infections/100,000 population in 2018 (p=0.003). Comprehensive case investigation identified putative overseas community acquisition. Median time between isolate referral and initial genomic and epidemiological assessment for local transmission was 11 days (IQR 9-14). Prospective surveillance identified numerous small transmission networks (median 2, range 1-19 cases), predominantly IMP and KPC, with median pairwise distance of 8 (IQR 4-13) single nucleotide polymorphisms; low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted response.Conclusions:We demonstrate the value of centralised CPE control programs to increase case ascertainment, resolve risk factors and identify putative local transmission through prospective genomic and epidemiological surveillance; methodologies are transferable to low-prevalence settings and MROs globally.

Item Type: Article
Authors/Creators:Lane, CR and Bret, J and Schultz, M and Gorrie, CL and Stevens, K and Cameron, DRM and St George, S and van Diemen, A and Easton, M and Stuart, RL and Sait, M and Peleg, AY and Stewardson, AJ and Cheng, AC and Spelman, DW and Waters, MJ and Ballard, SA and Sherry, NL and Williamson, DA and Romanes, F and Sutton, B and Kwong, JC and Seemann, T and Goncalves da Silva, A and Stephens, N and Howden, PJ
Keywords: antimicrobial resistance, public health surveillance, carbapenemase producing <i>Enterobacterales</i>, infection control, genomics
Journal or Publication Title: Clinical Infectious Diseases
Publisher: Univ Chicago Press
ISSN: 1058-4838
DOI / ID Number: 10.1093/cid/ciaa972
Copyright Information:

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) http://creativecommons.org/licenses/by-nc-nd/4.0/

Item Statistics: View statistics for this item

Actions (login required)

Item Control Page Item Control Page
TOP