The National Public Health Emergency Team on Carbapenemase-producing Enterobacteriaceae (CPE) held their eleventh meeting today, 25th January 2018.
The focus of the agenda and items discussed included enhanced surveillance of CPE and the latest figures from the National CPE Reference Laboratory.
The National Public Health Emergency Team identified that surveillance of CPE at a national level could be enhanced. Consequently, they requested that the Health Protection Surveillance Centre (HPSC) should prepare a monthly CPE surveillance report. The draft first report, from the HPSC, was presented at the meeting today. The HPSC collated data from across a number of data streams including National CPE Reference Laboratory data, HSE Business Intelligence Unit data and Departments of Public Health data to provide a more comprehensive national picture. The group acknowledged the work of the HPSC in developing the report agreed that subject to some final amendments the report will be published prior to the next NPHET meeting. The first report will include data for essentially all of 2017 though some data for December may be published in the January report. Subsequent reports will be published monthly.
The latest figures from the National CPE Reference Laboratory were presented to the group. In the week from 8th to 14th January 2018 a total of ten new patients with CPE were detected and in the week from 15th to 21st January 2018 there were eleven new patients identified.
The minutes of all previous meetings and related documents are published on a dedicated webpage on the Department of Health website.
Carbapenemase Producing Enterobacteriaceae CPE (also referred to as carbapenem resistant Enterobacteriaceae (CRE)) is a superbug resistant to most or all antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity.
CPE are gram-negative bacteria that are carried in the gut and are resistant to most, and sometimes all, available antibiotics. CPE are an established threat to human health, particularly in hospital settings. They are shed in the faeces and transmitted by direct and indirect contact. A period of 4 weeks or more may elapse between that contact that results in acquisition of the organism and the time at which CPE becomes detectable in the faeces of the contact. More than half of all patients who develop blood stream infections with CPE die as a result of their infection.
CPE has been identified throughout the world in recent years. Ireland has seen an increase in the number of cases year on year. The number of cases almost doubled in 2016 and is estimated to increase by a further third in 2017. The spread of this superbug in hospitals can lead to the closure of beds, wards and units removing thereby, essential capacity to provide services, to admit patients from Emergency Departments and to address waiting lists effectively.
Public Health and microbiological advice indicates that the opportunity remains for effective interventions to be taken which can protect our patients, protect our hospital capacity from unplanned closures and ultimately lead to a halting or reduction in the spread of this superbug.
A public health emergency is described as any serious or unexpected event, due to an infectious disease, which causes, or threatens to cause, death or serious illness to large sections of the population, an individual region or a specific cohort of individuals and which will have a major impact on the normal functioning of the health system and on society in general.
The Department of Health’s National Health Emergency Plan is a plan for activation in the event of a national/large-scale public health emergency in the event of an infectious disease outbreak or similar health issue. The purpose of the plan is to assist all health agencies in the State to respond to a public health emergency in an integrated and co-ordinated manner.
The National Public Health Emergency Team was convened as a result of the activation of the Public Health Emergency Plan, on 25 October 2017, by the Minister for Health (Mr Simon Harris TD) as a public health response to CPE in Ireland.
Antimicrobial resistance (AMR) is resistance of a microorganism to a drug that was originally effective for treatment of infections caused by that microorganism. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food handling encourage the further spread of AMR.
Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 aims to implement policies and actions to prevent, monitor and combat AMR across the health, agricultural and environmental sectors. Reducing the inappropriate use of antimicrobial medicines, as well as preventing infections and disease, is vital to stop the development and spread of resistant microorganisms.
It provides an overview for the health, agricultural and environmental sectors. It presents key strategic interventions for tackling antibmicrobial resistance in line with World Health Organisation (WHO) requirements across the three sectors. These interventions represent Ireland’s commitment to the development and implementation of a holistic, cross-sectoral ‘One Health’ approach to the problem of antimicrobial resistance.
A healthcare-associated infection (HCAI) is an infection that is acquired after contact with the healthcare services. This is most frequently after treatment in a hospital, but can also happen after treatment in outpatient clinics, nursing homes and other healthcare settings. Healthcare-associated infections that are picked up in hospital are also known as “hospital-acquired infections”.