Prof Jeffrey Lipman

May 2018

CTX-M ESBL-producing Enterobacteriaceae: estimated prevalence in adults in England in 2014

INFECTION CONTROL OF PATIENTS WHO HAVE RECENTLY TRAVELLED, OR ARE “FROM”, OVERSEAS.

The major value of this article is

  1. Travellers from regions with high prevalence of resistant organisms should be isolated on admission to ICU (Asia, Middle East, Africa, Southern Europe, even UK ie this article)
  2. the potential problems we and the rest of the world are having because of what some people are putting into the basket named “globalisation”;
  3. to show that Randomised Controlled Trials are not the only way to influence or change ICU practice;

Whilst we have ZERO horizontal spread in our ICU currently (ie a patient comes into bed 19 for example colonised with MRSA, MRSA is NOT carried by our staff such that other patients within the ICU become colonised), we have had spread previously, namely of acinetobacter and a resistant one at that.

Acinetobacter is a particular problem for a number of reasons. Firstly it can live on inanimate objects for up to 4-5 months (keyboards, door handles, bedrails, mattresses, bench-top surfaces, telephones etc, etc). Secondly it swaps genetic material more easily and frequently than any other groups of organisms (ie coexisting next to a resident pseudomonas, it can pick up that resistance gene easily). Thirdly it “spreads” more readily than other gram negatives ie the surrounds of colonised patients with acinetobacter have a lot more such organisms than patients colonised with E Coli for example.

Finally as an additional comment, full bacterial genomic analysis is becoming more common. Interestingly our UQCCR group are able to perform such analyses. They already have shown an identical resistant Enterobacteriaceae organism that caused problems in our ICU two years ago has been regrown this year in a patient! This can only mean this organism is surviving on/within a staff member! By itself this is not a problem but would need further investigation if we have an outbreak (a number of patients with same organism). Sophistication and new developments in bacterial genomic analysis will in time allow identification of resistant organisms and their ability to potentially acquire other resistance mechanisms with a turn around time of a couple of hours.

Check out the associated journal club presentation by Dr Marella and Prof Lipman here!