title: Universal hospital admission screening for carbapenemase-producing organisms in a low-prevalence setting.
abstract: Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging threat for healthcare providers worldwide.
  
  
  
  To determine CPE carriage rates and risk factors in an unselected hospital cohort at the time of admission.
  
  
  
  We approached 4567 patients within 72 h of admission to provide a rectal swab and answer a questionnaire on risk factors for carriage. Rectal swabs were cultured for carbapenem-resistant organisms on chromogenic and non-chromogenic agar, and tested for carbapenemase production by PCR (Check-Direct CPE). The study was approved by the NHS Research Ethics Committee.
  
  
  
  Only 6 CPE were cultured from 5 (0.1%) of 4006 patients who provided a rectal swab; only 1 was cultured using non-chromogenic media. An additional 76 culture-negative rectal swabs were initially PCR positive, but none grew a carbapenem-resistant organism despite enrichment culture and only two were positive when retested several months later by Check-Direct and a second PCR assay (Cepheid GeneXpert®Carba-R). A modified Ct cut-off of <35 would have resolved these apparent false-positives. 40% of patients had a risk factor that should prompt screening and pre-emptive isolation as defined by UK CPE guidelines but only 8.1% and 20.2% of these patients had been screened and pre-emptively isolated by clinical teams, respectively. Overseas hospitalization was the only significant risk factor for CPE carriage (P < 0.001, OR 64.3, 95% CI 7.3-488.5).
  
  
  
  This study highlights a very low carriage rate of CPE. Hospitalization abroad is the most important risk factor to guide admission screening in this low-prevalence setting.
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Jonathan A
authors: JA
authors: Otter
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Eleonora
authors: E
authors: Dyakova
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Karen N
authors: KN
authors: Bisnauthsing
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Antonio
authors: A
authors: Querol-Rubiera
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Amita
authors: A
authors: Patel
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Chioma
authors: C
authors: Ahanonu
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Olga
authors: O
authors: Tosas Auguet
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: Jonathan D
authors: JD
authors: Edgeworth
authors: Centre for Clinical Infection and Diagnostics Research (CIDR), Department of Infectious Diseases, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, UK simon.goldenberg@gstt.nhs.uk.
authors: Simon D
authors: SD
authors: Goldenberg
mesh_terms: D000328:Adult; D001426:Bacterial Proteins / Q000032:analysis*; D001431:Bacteriological Techniques; D002353:Carrier State / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D003955:Diagnostic Tests, Routine / Q000379:methods*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D060005:Genotyping Techniques; D006761:Hospitals; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012007:Rectum / Q000382:microbiology; D011795:Surveys and Questionnaires; D006113:United Kingdom; D001618:beta-Lactamases / Q000032:analysis*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase