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CPE is ‘creeping pandemic’, warns HSE AMR Lead

Consultant Microbiologist Prof Martin Cormican, who took over as HSE Lead in May, informed delegates that if CPE is not tackled now it will become endemic in the system, as occurred with MRSA, VRE and ESBL. While he was unsure whether this could be avoided, he said every effort must be made to deal with the situation.

CPE are non-susceptible to carbapenem via production of a carbapenemase enzyme. The carbapenem class of antibiotics are the ‘drugs of last resort’ for life-threatening infections.

There were six CPE cases per week in 2016 and this year “it looks like it is going to be 10-to-12”.

Prof Cormican referenced a case study where an Irish female patient picked up CPE abroad. The patient now has cystitis and the only antibiotic treatment option is colistin, which is IV-administered and nephrotoxic.

Speaking on HCAI and AMR in general, Prof Cormican said “faeces is the business of infection-control doctors to a large extent and most of the things that spread in hospitals spread because one patient has swallowed microscopic traces of somebody else’s faeces”. This underlined the importance of correct hand-washing technique in healthcare, he said.

He said “virtually everybody who gets oncology care in many of our major hospitals picks up an antibiotic-resistant bug called VRE. That means that virtually everybody who gets oncology care in most of our major hospitals is swallowing traces of other patient’s faeces”.

The microbiologist said “clean, safe care should be a reasonable expectation of patients and we are not doing that now… that is very clear because people are picking up [bugs]”.

Prof Cormican emphasised the importance of informing patients that antibiotics do more harm than good when they are not medically indicated.

Speaking to the Medical Independent (MI), Prof Cormican said one of the big challenges in dealing with CPE in Ireland is “very high bed occupancy”. Asked whether the HSE had come forward with significant resources for the response effort, he said “there is a lot of discussion going on with the Department of Health about the budgeting for next year and a lot of discussion within the HSE about how this is going to be managed”.

Current indications of a “substantially higher” number of CPE cases in 2017 is a “huge concern”, acknowledged Prof Cormican, adding that increased screening is a relevant factor.

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