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Ireland ‘running out of time’ on CRE – leading microbiologists

The window of opportunity to prevent carbapenem-resistant Enterobacteriaceae (CRE) from becoming endemic in Ireland’s hospital system is “diminishing rapidly”, the President of the Irish Society of Clinical Microbiologists (ISCM) has told the Medical Independent (MI).

ISCM President Dr Eleanor McNamara told MI that it represents a “major” patient safety issue.

In Ireland, confirmed cases of carbapenemase-producing Enterobacteriaceae (CPE), a subset of CRE implicated in Irish and international outbreaks, have increased dramatically between 2013 and 2016, according to statistics from the national CPE reference lab (48 confirmed cases in 2013; 81 in 2014; 140 in 2015; and 369 in 2016).

On 24 August 2016, Tallaght Hospital, Dublin, notified what has constituted the biggest CRE outbreak to date in an Irish hospital. In November, a HSE report described the hospital as “overwhelmed” by OXA-48 type CRE/CPE. Several other Irish hospitals and long-term care facilities have been affected by various forms of CRE/CPE in 2016 and 2017. The midwest has a longstanding issue with Klebsiella pneumoniae carbapenemase (KPC) CPE.

Dr McNamara said that an emergency national outbreak team with dedicated resources, and a longer-term strategic focus in parallel, are urgent requirements.

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

Outbreaks in Irish healthcare have mainly involved colonisation. However, carriers serve as a reservoir that facilitate proliferation and increased risk of infection.

Healthy people are unlikely to suffer ill-effects arising from CRE colonisation. However, vulnerable patients are at risk of developing invasive infection, which is associated with high mortality.

Prof Martin Cormican, Professor of Bacteriology, NUI Galway, said that “if we are to have any chance of controlling this, we need much more effective leadership from the Minister for Health and the Department of Health than we have seen to date”.

He said a number of Irish hospitals experiencing major outbreaks have “managed to limit spread”, but at “considerable cost and disruption of service”.

It has also emerged that Minister for Health Simon Harris asked officials to find out if there was a CRE outbreak at Tallaght Hospital, some three weeks after the situation had been notified to the local HSE public health department.

See news investigation, pages 4-6

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