Systemised surveillance of superbugs
Klebsiella pneumonia Carbapenemase (KPC) producing bacteria are resistant to a number of last line antibiotics. What’s more, this resistance spreads rapidly.
KPC producing bacteria have been associated with high morbidity and mortality in countries such as Greece, Israel and Eastern parts of the United States, and in 2012, there was an outbreak in a Victorian hospital.
A few years later, the Microbiological Diagnostic Unit (MDU) Public Health Laboratory at the Doherty Institute was brought on to help investigate.
“It wasn’t clear why KPC cases were still being detected in Victoria, and if they were spreading here,” explains University of Melbourne Professor Ben Howden, Director of MDU.
Using whole genome sequencing and epidemiological data from multiple hospitals across Victoria, the MDU team found that because of the bacteria’s ability to colonise the gut, a single facility won’t always be able to track all the transmissions that may have occurred. This is because infections are often identified in other facilities years down the track.
It was this finding that led the Department of Health and Human Services to implement a centralised and systemised surveillance system conducted by the Doherty Institute for Carbapenemase-Producing Enterobacteriacaea (CPE). These are certain types of bacteria, such as KPC producers, that are resistant to carbapenems, a class of ‘last resort’ antibiotics used for treating serious infections.
One of their first roles was to develop a set of guidelines, Victorian guidelines on carbapenemase-producing Enterobacteriaceae, for the surveillance and management CPE.
“The guidelines introduced active screening and outlined how hospitals and other healthcare facilities should respond to confirmed cases and outbreaks, so we had standardised practices across the state,” explains Infection Control Consultant for VICNISS at the Doherty Institute, Judy Brett.
The program has seen a reduction in the proportion of CPE-causing active clinical infections in Victoria. The incidence of CPE has increased over the surveillance period, however active clinical infections remained steady.
“That says to me that screening is working,” says MDU Epidemiologist, Courtney Lane.
“We’re identifying more people colonised with CPE who are carrying it around without symptoms, so control measures to stop transmission can be put in place.”