Community-acquired carbapenemase-producing organism detected

Residents of retirement communities in South Surrey/White Rock (Sunnyside Manor and Crescent Gardens) have been found to be colonized with a carbapenemase-producing organism (CPO), specifically E. coli with NDM (New Delhi metallo-beta-lactamase). Although a few of these CPO cases are likely hospital-acquired, investigations to date suggest that most cases have resulted from local community exposure. 

CPOs are multi-drug resistant gram-negative bacteria resistant to carbapenem antibiotics. These bacteria may colonize the gut, where they do not cause symptoms. However, they can spread beyond the gut and cause infections, including UTIs, bloodstream infections, and wound infections, for which antibiotic treatment options are limited. In addition, there is a risk of spread from colonized or infected individuals to vulnerable patients in healthcare facilities. Colonized individuals (carriers) can transmit the bacteria to others through the fecal-oral route. 

As part of ongoing surveillance to detect and prevent hospital spread of CPOs, Fraser Health hospitals, including Peace Arch Hospital, screen new in-patients (by rectal swab culture) who may be at higher risk of carrying CPOs. An important risk factor for prior exposure to CPOs is a history of receiving health care anywhere outside of Canada, or travel to CPO-prevalent regions, including India, Pakistan and Bangladesh. In response to recent detection of CPOs among community residents without these risk factors, hospital admission CPO screening is being selectively expanded to also include persons residing in retirement communities where community spread of CPO is suspected. Fraser Health is promoting screening of residents and staff of affected facilities, as well as working closely with the two facilities to monitor and ensure optimal practices in infection prevention and control.

Public Health is requesting your assistance with the following:

• Staff and current residents of both Crescent Gardens and Sunnyside Manor have been given letters and lab requisitions for CPO screening to take to their health care provider. If your patient comes to you with this requisition, please arrange screening as soon as possible. CPO screening involves a regular swab culture of your patient's perianal area or rectum, and it is important that the swab be visibly stained with fecal material. The specimen or swab can be forwarded as per your normal office protocol to LifeLabs for further processing
• If one of your patients is identified as CPO colonized, ensure that your patient indicates that they are CPO-positive when going to any other health care settings so that appropriate infection control precautions can be taken. 
• Please take every opportunity to remind your patients and staff of the importance of consistent, good personal hygiene, particularly handwashing, to help prevent further spread not only of CPOs, but other community-acquired infections. 

Note that in the event of a positive CPO result, gut decolonization is not recommended; attempts at eradicating multi-drug resistant gram-negative organisms from the gastrointestinal tract have generally been unsuccessful and may lead to more resistance. Furthermore, CPO screening of people who are not linked to these two retirement communities or do not have clear risk factors is currently not recommended.