Community prevalence of carbapenemase-producing organisms in East London

Abstract

Background: Over the last decade there has been a rapid, worldwide increase in carbapenem resistance, which is of growing concern. The main protagonists, the carbapenemases Klebsiella pneumoniae carbapenemase (KPC), oxacillinase β-lactamase 48 (OXA-48), imipenemase metallo-β-lactamase (IMP), Verona integron-borne metallo-β-lactamase (VIM), and New Delhi metallo-β-lactamase (NDM) have also been reported across the UK. However, these reports are derived from a combination of reactive screening, outbreak control, inpatient surveillance, and diagnostic samples. Therefore, the true community prevalence is unknown.

Aim: To determine the community prevalence of carbapenemase-producing organisms (CPOs) in the area served by Barts Health NHS Trust.

Methods: Active screening of 200 non-duplicate community stool samples was performed. Patient demographics and foreign travel history were extracted from the laboratory information management system to identify potential risk factors for carriage of CPOs.

Findings: Patients in this study were aged from one to 93 years and were evenly distributed between male and female. Foreign travel in the last year was listed for 46 out of 200 (23%) patients, with the most commonly visited countries including Bangladesh (4%), India (2.5%), Morocco (2%), and Turkey (1.5%). However, only one patient tested positive for a CPO, an NDM-producing Pseudomonas aeruginosa, and this patient had travelled to the Caribbean.

Conclusion: To date, there have been no studies investigating the prevalence of CPOs in the UK community. Given the high-risk patient population served by Barts Health NHS Trust, it is reassuring that the prevalence observed here was low. However, it should be highlighted that travel to countries not previously categorized as high risk may also pose a threat.

Keywords: Carbapenemase; Community; Prevalence; Screening; Surveillance.