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CPE remains ‘emergency’ but control measures impacted by Covid-19

By Catherine Reilly - 20th Apr 2020

The spread of carbapenemase-producing enterobacterales (CPE) remains a designated national public health emergency, but crucial surveillance and control measures are being curtailed by the Covid-19 crisis.

The CPE emergency was declared by Government in October 2017 following “a rapid and worrying increase” in incidence. CPE are considered a growing threat to public health internationally due to very limited options for treatment of infection. The 30-day mortality of CPE bloodstream infection is approximately 50 per cent, despite the application of empirical treatment.

According to the Health Protection Surveillance Centre (HPSC), the annual total number of isolates from patients with newly-confirmed CPE submitted to the reference laboratory increased from 50 in 2013 to 537 in 2018. In the first half of 2019, some 346 confirmed CPE isolates from 346 patients were reported by microbiology laboratories.

There were 16 notifications of invasive infection in 2018, and 15 to the end of November 2019.

“As with every element of the health service, it has been necessary to prioritise management of Covid-19. Data collection and reporting on CPE has been deferred to allow hospitals to concentrate on managing Covid-19,” a HSE spokesperson told the Medical Independent (MI).

“While every effort is being made to maintain CPE screening and reference laboratory services, laboratories have been obliged to prioritise development and delivery of testing for Covid-19 in exceptionally difficult conditions. This is likely to impact, at least in the short term, on some aspects of other laboratory work.”

Screening is considered a crucial tool in combating CPE, as it allows hospitals to better prevent spread to other patients and staff. It also helps hospitals to reduce the risk of CPE-colonised patients developing infection during medical treatment.

A HSE report covering January-February 2019 stated there was “no indication” that spread of CPE in the acute system had been “effectively controlled to date”.

At that stage, the HSE was awaiting further resourcing for screening. The Executive had informed the Department of Health that a delay in implementing screening guidance materially increased the risk that CPE would become “irreversibly endemic” in the healthcare system.

In February 2019, HSE National Lead for Healthcare-Associated Infection and Antimicrobial Resistance Prof Martin Cormican told MI that despite some “very good progress” in 2018, “we will need to up the game quite a bit in 2019 and 2020 if we are actually going to try and put this back in the box”.

The CPE national public health emergency team was due to meet early this year, with a view to standing down the emergency status. However, a date for this meeting is still being considered following the Covid-19 crisis.

MI understands CPE may be categorised as a “strategic threat” to the healthcare system to reflect ongoing concern about the risks posed.

A Department spokesperson said that while the number of newly-diagnosed CPE patients had increased, this was “in the context of substantially increased screening activity over the past year”.

In 2018 and 2019, the Department provided targeted antimicrobial resistance funding to the HSE totalling €6.6 million in full-year costs.

“Infection prevention and control remain an ongoing priority for the health system,” it stated.

The HPSC’s monthly report on CPE is deferred, as staff have been redeployed to assist with Covid-19 support.

It is unclear what impact cancellation of hospital procedures, and heightened infection prevention and control measures to combat the novel coronavirus, may have on the spread of CPE.

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