Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures.
To estimate UK prevalence and incidence of clinically significant carbapenemase-producing Enterobacteriaceae (CPE), and to determine epidemiological characteristics, laboratory methods and infection prevention and control (IPC) measures in acute care facilities.



A 6 month survey was undertaken in November 2013-April 2014 in 21 sentinel UK laboratories as part of the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project. Up to 10 consecutive, non-duplicate, clinically significant and carbapenem-non-susceptible isolates of Escherichia coli or Klebsiella pneumoniae were submitted to a reference laboratory. Participants answered a questionnaire on relevant laboratory methods and IPC measures.



Of 102 isolates submitted, 89 (87%) were non-susceptible to ≥1 carbapenem, and 32 (36%) were confirmed as CPE. CPE were resistant to most antibiotics, except colistin (94% susceptible), gentamicin (63%), tigecycline (56%) and amikacin (53%). The prevalence of CPE was 0.02% (95% CI = 0.01%-0.03%). The incidence of CPE was 0.007 per 1000 patient-days (95% CI = 0.005-0.010), with north-west England the most affected region at 0.033 per 1000 patient-days (95% CI = 0.012-0.072). Recommended IPC measures were not universally followed, notably screening high-risk patients on admission (applied by 86%), using a CPE 'flag' on patients' records (70%) and alerting neighbouring hospitals when transferring affected patients (only 30%). Most sites (86%) had a laboratory protocol for CPE screening, most frequently using chromogenic agar (52%) or MacConkey/CLED agars with carbapenem discs (38%).



The UK prevalence and incidence of clinically significant CPE is currently low, but these MDR bacteria affect most UK regions. Improved IPC measures, vigilance and monitoring are required.
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.|Department of Medical Microbiology, Hôtel-Dieu du CHU de Québec - Université Laval, 11 Côte du Palais, Québec, QC G1R 2J6, Canada.
Pascale
P
Trepanier
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Kim
K
Mallard
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Danièle
D
Meunier
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Rachel
R
Pike
Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK.
Derek
D
Brown
City Hospital, Dudley Road, Birmingham B18 7QH, UK.
Janet P
JP
Ashby
Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
Hugo
H
Donaldson
East and North Hertfordshire NHS Trust, Lister District General Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK.
F Mustafa
FM
Awad-El-Kariem
Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK.
Indran
I
Balakrishnan
Brighton and Sussex University Hospital NHS Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK.
Marc
M
Cubbon
Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK.
Paul R
PR
Chadwick
Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough PE3 9GZ, UK.
Michael
M
Doughton
Public Health England, Microbiology Services Division, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK.
Rachael
R
Doughton
Alder Hey Children's NHS Foundation Trust, East Prescot Rd, Liverpool L14 5AB, UK.
Fiona
F
Hardiman
The Shrewsbury & Telford Hospital NHS Trust, Mytton Oak Road, Shrewsbury, Shropshire SY3 8XQ, UK.
Graham
G
Harvey
Regional Laboratory Leeds, National Infection Service, Public Health England, Old Medical School, Thoresby Place, Leeds LS1 3EX, UK.
Carolyne
C
Horner
Royal Hospital Cornwall, 2 Penventinnie Lane, Treliske, Truro, Cornwall TR1 3LQ, UK.
John
J
Lee
Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK.
Jonathan
J
Lewis
Belfast Health and Social Care Trust, Belfast City Hospital, 51 Lisburn Road, Belfast BT9 7AB, UK.
Anne
A
Loughrey
Public Health Laboratory London, Department of Infection, Barts Health NHS Trust, 80 Newark Street, London E1 2ES, UK.
Rohini
R
Manuel
Sheffield Teaching Hospital NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
Helena
H
Parsons
Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, Tyne and Wear NE7 7DN, UK.
John D
JD
Perry
Royal Free London NHS Foundation Trust, Pond St, London NW3 2QG, UK.
Gemma
G
Vanstone
Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.
Graham
G
White
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Nandini
N
Shetty
Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK.
John
J
Coia
Health Protection Scotland, 5 Cadogan Street, Glasgow G2 6QE, UK.
Camilla
C
Wiuff
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK katie.hopkins@phe.gov.uk.
Katie L
KL
Hopkins
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Neil
N
Woodford
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics*; D015373:Bacterial Typing Techniques; D015780:Carbapenems / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology*; D004926:Escherichia coli / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics*
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase