The objective of the European Survey on CPE (EuSCAPE) was to provide the first comparable and quality-controlled data on the occurrence of the most important carbapenemase-producing Enterobacteriaceae (CPE – Klebsiella pneumoniae and Escherichia coli) as causes of infection (colonisation was not studied) in Europe and neighbouring countries, and to establish a framework for future enhanced sentinel surveillance. The survey also provides the first comparable and laboratory-substantiated data on the incidence of CPE producers across Europe.
The EuSCAPE survey has strengthened the development of diagnostic and national expert laboratory and epidemiological surveillance capability in participating countries via use of standardised (EUCAST) antimicrobial testing methodology, a training course, EQA distribution, and a standardised structured survey of cases.
Two articles have been published recently in relation to the European survey on CPE:
- Grundmann H, Glasner C, Albiger B et al. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infectious Diseases. [Preprint] 2016. Available from: http://www.sciencedirect.com/science/article/pii/S1473309916302572. (accessed 21 November 2016).
- Trepanier P, Mallard K, Meunier D et al. Carbapenemase-producing Enterobacteriaceae in the UK: a national study (EuSCAPE-UK) on prevalence, incidence, laboratory detection methods and infection control measures. Journal of Antimicrobial Chemotherapy. [Preprint] 2016. Available from: http://jac.oxfordjournals.org/content/early/2016/09/28/jac.dkw414.abstract. (accessed 21 November 2016).
Between November 2013 and April 2014, 455 sentinel hospitals from 36 countries participated in EUSCAPE. Health Protection Scotland, SSSCDRL (as National Expert Laboratory), Glasgow and Edinburgh laboratories and 13 Scottish hospitals participated alongside Public Health England’s AMRHAI Reference Unit and 19 sentinel laboratories across the UK.
Across Europe, on average, 1.3 patients per 10,000 hospital admissions had CPE-positive clinical specimens and 2.51 per 100,000 patient days. The Scottish rate was 0.03 per 10,000 hospital admissions and 0.1 per 100,000 patient days.
Incidence differed greatly, with the highest rates of incidence in Mediterranean and Balkan countries (including Greece, Italy, Montenegro, Spain, and Serbia).
The project also facilitated further detailed studies within the UK (see article 2). The incidence of CPE across the UK was 0.7 per 100,000 patient-days, with north-west England the most affected region at 3.3 per 100,000 patient-days (Scotland: 0.1 per 100,000 patient days).
The UK study showed that recommended IPC measures were not universally followed in participating laboratories and hospitals, including:
- screening high-risk patients on admission (applied by 86%);
- using a CPE ‘flag’ on patients’ records (applied by 70%);
- alerting neighbouring hospitals when transferring affected patients (applied by only 30%);
- having a laboratory protocol for CPE screening (applied by 86%).
The Scottish and UK prevalence and incidence of clinically significant CPE is currently low, but these multi-drug resistant bacteria affect most UK regions. Improved infection prevention and control (IPC) measures, vigilance and monitoring are required. The emergence and spread of antibiotic resistance against last-line antibiotics increasingly erodes the ability to treat patients infected with CPE successfully, especially in countries where CPE prevalence in hospitals is high. At a time when few novel and effective antibiotic compounds have become available, containment of CPE is bound to rely on stricter IPC measures in hospitals.