The ‘Phantom Menace’ an outbreak of E.coli OXA48 like CPE

Belinda Henderson1, Catherine Watson1, Sally Healy1, Margaret Lindsay1, Geoffrey Playford1, Naomi Runnegar1, Joel Douglas2, Jennine Hay2, Patrick Harris 2,3

1Infection Management Services, Princess Alexandra Hospital, Brisbane, 4102.
2Pathology Queensland, Princess Alexandra Hospital, Brisbane, 4102
3University of Queensland, Centre for Clinical Research, Brisbane


Just like in the George Lucas classic infection prevention and control staff at the Princess Alexandra Hospital hoped to secure a peaceful end to a large-scale outbreak of the relatively unknown and unseen ST28 OXA48 like E.coli. In a suburb south of the river far far away D day began like any other day when it was noted that we had a trilogy of identical isolates of ESBL producing E.coli with an unusual antibiogram, and an elevated but technically susceptible meropenem MIC. The Jedi council undertook further testing and we entered a state of hyperdrive. Upon review this organism made ‘vader’ look like a friendly little ‘ewok’. The ‘dark side’ was upon us and the resistance was prevalent. This paper will explore the challenges and complexities, workload and management of this organism and outline the exciting potential of whole genome sequencing in the context of an outbreak.

The prevalence of multi-drug resistant organisms is increasing internationally, and the ability for these organisms to jump from galaxy to galaxy via international travellers brings a new layer of complexity for those responsible for infection prevention and control. An increased focus on those who have received international healthcare is something that hospitals need to focus and improve upon. Our experience highlights the importance of the ‘force being with you’ with hand hygiene, cleaning and screening key to expelling the stormtroopers.

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