(duplicate) Enhanced surveillance for resistant Gram-negative bacteria v1.0
Research type
Research Study
Full title
Enhanced surveillance for resistant Gram-negative bacteria at admission to a London Teaching Hospital
IRAS ID
168268
Contact name
Jonathan Otter
Contact email
Sponsor organisation
Guy's & St Thomas' Foundation NHS Trust
Duration of Study in the UK
0 years, 9 months, 1 days
Research summary
Gram-negative bacteria resistant to the carbapenem class of antibiotics, (carbapenem-resistant organisms or CROs), are emerging rapidly worldwide. These antibiotic-resistant bacteria, defined by resistance to our last line antibiotics (carbapenems), leave few, and sometimes no, therapeutic options. CRO are presumed to be rare at Guy’s and St. Thomas’ NHS Foundation Trust (GSTT), with around 30 cases in the past 18 months, linked with outbreaks on the intensive care unit (ICU) and an orthopaedic ward. However, they are increasing more rapidly in other South London hospitals. Given frequent transfer of high-risk patients between South London hospitals and the fact that our ethnically diverse local population frequently visit high-prevalence countries, all Trusts in the same region are at risk of an emerging epidemic. This concern is echoed nationally with a recent Patient Safety Alert from NHS England to all hospital CEOs prioritising implementation of a Toolkit to support identification and control of CRO. There is understandable concern given our experience with MRSA, which was not addressed until it had become endemic in UK hospitals and took a decade to bring under control. Although extended-spectrum beta lactamase (ESBL) producing Enterobacteriaceae (ESBL) are less problematic clinically than CRE, they are considerably more common. Thus, we will also include the detection of, and assessment of risk factors for, colonisation with ESBL.
We think it likely that undetected CRO and ESBL are present in patients at the time of admission, which is a risk for transmission in hospitals. A rectal and perineal swab will be collected from all patients admitted to GSTT. Patients will be asked a simple questionnaire at the time of swab collection to establish risk factors. Samples will be tested for the presence CRO and ESBL. The prevalence of CRO and ESBL, CRO resistance genes, and any clinically relevant associations will be reported.REC name
London - Camberwell St Giles Research Ethics Committee
REC reference
14/LO/2085
Date of REC Opinion
29 Dec 2014
REC opinion
Further Information Favourable Opinion