Lessons learned during the investigation and management of KPC transmission in a long-term residential care facility

Ms Donna Cameron1,2, Ms Judith Brett3, Ms Courtney Lane1, Dr Annaliese van Diemen2, Ms Marion Easton2, Mr Brett Morris2, Dr Mark Schultz1,4, Dr Jason Kwong1,4,5, Prof Benjamin Howden1,4,5

1Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Parkville, Australia,

2Department of Health and Human Services, Melbourne, Australia,

3VICNISS Healthcare Associated Infection Surveillance Coordinating Centre, Melbourne, Australia,

4Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia,

5Department of Infectious Diseases, Austin Health, Melbourne, Australia

Introduction

Carbapenemase-producing Enterobacteriaceae (CPE) are an urgent antimicrobial resistance public health threat. Internationally, long-term residential care facilities (LTRCFs) have been frequently associated with high levels of multi-resistant organisms, and increasing rates of CPE colonisation.

 The Victorian guideline on CPE for health services was first released in December 2015 introducing centralised surveillance and standardised management of CPE cases and transmission across Victoria. Genomic and epidemiological analyses are used to identify possible local transmission, with management overseen by the Victorian CPE Incident Management Team (VCIMT).

 Methods

In March 2016 a blaKPC positive Klebsiella pneumoniae (KP-KPC) isolate was identified in a resident of a 160-bed LTRCF. A second case in the same LTRCF was identified from surveillance data. Despite a second shared exposure to an acute-care hospital associated with previous KP-KPC cases, genomic and epidemiological analyses indicated the isolates from the two residents were closely related and suggested transmission had occurred within the facility.

 Results

Guided by the VCMIT, a multidisciplinary response was instigated. This included: the implementation of infection control measures, education of staff, residents and families and participation of 163 residents in up to three rounds of screening held at one, three and six month intervals. No further CPE cases were identified.

 Conclusions

Centralised integrated genomic and epidemiological surveillance enabled the identification of likely CPE transmission in a LTRCF. Following the implementation of a number of measures, no further cases of transmission were detected. Lessons learned from this incident have informed the development of the Victorian guideline on CPE in LTRCFs.


Biography:

Donna currently works as an infection control consultant with the Microbiological Diagnostic Unit Public Health Laboratory and Communicable Diseases Prevention and Control at the Victorian Department of Health and Human Services where she provides infection control advice to non-acute healthcare facilities and other community-based practices, such as beauty therapists and tattoo artists. It is also though this position that she has been involved with the development and implementation of both the Victorian guideline on Carbapenemase-producing Enterobacteriaceae for health services (versions 1 & 2) and the Victorian guideline on Carbapenemase-producing Enterobacteriaceae for long-term residential care facilities.

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