title: Carbapenemase-producing Enterobacteriaceae: use of a dynamic registry of cases and contacts for outbreak management.
abstract: BACKGROUND
  The emergence and spread of carbapenemase-producing Enterobacteriaceae (CPE) have become a major public health problem. Control and prevention of CPE infections hinge on isolation precautions for carriers and active screening and follow-up of contacts.
  
  
  OBJECTIVE
  To implement an open registry of cases and contacts for acute outbreak management, long-term data collection and epidemiological investigation.
  
  
  METHODS
  All cases, defined as patients (infected or colonized) with a CPE-positive culture during their hospitalization, and contacts (e.g. patients cared for by the same healthcare team as a case) were registered in an ongoing database. Hospital stays were cross-referenced for every new entry and epidemiological links (e.g. shared contacts) investigated. All cases and contacts not cleared by complete screening were registered on an active list.
  
  
  RESULTS
  Between October 2012 and November 2014, we registered 30 cases and 1268 contacts, among which 24 were linked to two or three separate cases. Only 6.5% of contacts fulfilled complete screening with three rectal swabs, and 1145 contacts are still registered on the active surveillance list. Two outbreaks (12 and nine cases) occurred nine months apart. Cross-referencing of hospital stays using the registry revealed epidemiological links between seemingly unrelated cases of CPE-positive patients and suggested an environmental source of transmission, which was demonstrated thereafter.
  
  
  CONCLUSIONS
  We implemented a simple and multi-purpose tool to manage CPE episodes and investigate epidemiological links. Efforts are necessary to improve screening of contact patients who may be occult sources of transmission. A regional registry could be helpful.
authors.affiliation: Department of Infection Control and Prevention, University Hospital of Montpellier, France.
authors.forename: B
authors.initials: B
authors.lastname: Clarivet
authors.affiliation: Department of Microbiology, University Hospital of Nîmes, France; INSERM U1047 Nîmes, UFR Medecine, University of Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Pantel
authors.affiliation: Department of Infection Control and Prevention, University Hospital of Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Morvan
authors.affiliation: Department of Bacteriology-Virology, University Hospital of Montpellier, France.
authors.forename: H
authors.initials: H
authors.lastname: Jean Pierre
authors.affiliation: Department of Infection Control and Prevention, University Hospital of Montpellier, France; Team Pathogènes Hydriques Santé Environnement, UMR 5569 HydroSciences Montpellier, Unité de Bactériologie, UFR Pharmacie, University of Montpellier, France.
authors.forename: S
authors.initials: S
authors.lastname: Parer
authors.affiliation: Department of Infection Control and Prevention, University Hospital of Montpellier, France; Team Pathogènes Hydriques Santé Environnement, UMR 5569 HydroSciences Montpellier, Unité de Bactériologie, UFR Pharmacie, University of Montpellier, France.
authors.forename: E
authors.initials: E
authors.lastname: Jumas-Bilak
authors.affiliation: Department of Infection Control and Prevention, University Hospital of Montpellier, France; Team Pathogènes Hydriques Santé Environnement, UMR 5569 HydroSciences Montpellier, Unité de Bactériologie, UFR Pharmacie, University of Montpellier, France. Electronic address: a-lotthe@chu-montpellier.fr.
authors.forename: A
authors.initials: A
authors.lastname: Lotthé
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000378:metabolism*; D002648:Child; D016358:Contact Tracing; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology* / Q000635:transmission; D005260:Female; D006282:Health Personnel; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012042:Registries; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenemase-producing Enterobacteriaceae; Database; Outbreak management; Registry