Recommendation for NHSScotland

The literature on identifying carbapenemase producing Enterobacteriaceae in hospital screening samples is inadequate to inform selection of tests. Considerations around screening test selection should include:

• The prevalence of each carbapenemase in the at-risk population
• Individual clinical microbiology laboratory and overall service capabilities
• The ability to identify high risk patient groups and
• Availability of and costs associated with isolation beds.

Selection of the most appropriate test(s) for NHSScotland will require consensus around the balance between overall costs and turnaround times alongside an understanding of the strengths and limitations of each testing strategy in terms of the accuracy and utility of the information each provides both within a routine screening context and in an outbreak situation.

NHSScotland is required to consider the Scottish Health Technologies Group (SHTG) advice.

What were we asked to look at?

What is the published evidence on the accuracy, turnaround time and cost/costeffectiveness of tests to identify carbapenemase producing Enterobacteriaceae (CPE) in hospital screening samples obtained from patients identified as at risk of CPE colonisation during clinical risk assessment?

Why is this important?

The rapid emergence and spread of Enterobactericeae resistant to carbapenems is a critical clinical and public health issue.

In August 2013 a letter from the Chief Medical Officer, Chief Nursing Officer and Chief Pharmaceutical Officer to NHS Boards in Scotland set out the threat posed by this issue, the increasing instances of CPE detection in Scotland and the principles for combating the threat. In addition to early detection and prudent antibiotic prescribing, the requirement for the implementation of screening and infection control measures was detailed.

A rectal swab is considered the best sample type for screening in this context. To date the use of screening to identify asymptomatic carriers is variable across Scotland with many NHS boards screening only on an ad hoc basis. 

Referred by

Health Protection Scotland