During a national conference in February this year, the rest of the country learnt about a serious outbreak of carbapenem resistant Klebsiella pneumoniae (KPC2 type, a form of CRE or carbapenem-resistant Enterobacteriaceae) that was detected first in 2012 and has mainly focused around one Melbourne hospital. Last week, the media told us not much more about the outbreak, including some evidence of mortality. Detection of CRE does not require public health notification at present. See also this NPS Medicinewise report.
KPC organisms have been responsible for extensive, difficult-to-control outbreaks in Israel and the USA. They have become endemic in Greece and other countries where they are largely resistant to all available antibiotics. These outbreaks have been associated with invasive infections that have mortality rates in excess of 50%.
The recently released Hunter New England MDRO HealthPathway gives further guidance about what to do if you have a CRE patient come to your practice. Additional infection control precautions are advised! However, clearly most of the time, you will not realise that a patient is colonised with an MDRO, hence maintenance of a high level of hand and environmental hygiene for all patients (so called ‘Standard Precautions’) is crucial.
Still confused? This recent blog posting from Dr Jon Otter might help. Also this one – Do you know your CRO from your CPO from your CRE from your CPE?
[In reality, it is the carbapenemase-producing organisms (CPO) that are the cause of bother. This broader definition includes most carbapenem-resistant Acinetobacter baumannii isolates and a small proportion of carbapenem-resistant Pseudomonas aeruginosa isolates, most often described in outbreaks amongst ICU or Cystic Fibrosis patients (rare in Australia). Non-carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa is usually NOT multi-resistant and has a porin or efflux mechanism responsible for carbapenem resistance. ]