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The clear and present danger of carbapenemase-producing Enterobacteriaceae (CPE) in New Zealand: time for a national response plan.

Abstract Antimicrobial resistance (AMR) in general poses a threat to the sustainability of modern healthcare, but a particularly urgent and serious threat is posed by a specific group of antibiotic-resistant bacteria known as carbapenemase-producing Enterobacteriaceae (CPE). CPE are resistant to nearly all antibiotics and include common pathogens such as Escherichia coli and Klebsiella pneumoniae. In New Zealand, the incidence of CPE has increased from three isolates in 2012 to 45 in 2016. The current epidemiology of CPE in New Zealand has similarities with the extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) epidemic in the early 2000s (just before ESBL-PE underwent a non-linear increase in incidence). Although to date in New Zealand, nearly all CPE have been imported from overseas, this situation appears to be changing, with evidence of secondary spread in both households and healthcare facilities over the last year. In this article, we argue that CPE should be regarded as the foremost AMR threat currently facing New Zealand, and highlight the need for a comprehensive national response plan, analogous to plans for other emerging transmissible infections, such as pandemic influenza and Ebola. We also make recommendations about the components of such a plan and advocate that CPE should be recognised as a key priority in New Zealand's national AMR strategy, due to be published in May 2017.
PMID
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Authors

Mayor MeshTerms

Drug Resistance, Bacterial

Travel

Keywords
Journal Title the new zealand medical journal
Publication Year Start




PMID- 28449019
OWN - NLM
STAT- MEDLINE
DA  - 20170427
DCOM- 20170502
LR  - 20170502
IS  - 1175-8716 (Electronic)
IS  - 0028-8446 (Linking)
VI  - 130
IP  - 1454
DP  - 2017 Apr 28
TI  - The clear and present danger of carbapenemase-producing Enterobacteriaceae (CPE) 
      in New Zealand: time for a national response plan.
PG  - 72-79
AB  - Antimicrobial resistance (AMR) in general poses a threat to the sustainability of
      modern healthcare, but a particularly urgent and serious threat is posed by a
      specific group of antibiotic-resistant bacteria known as carbapenemase-producing 
      Enterobacteriaceae (CPE). CPE are resistant to nearly all antibiotics and include
      common pathogens such as Escherichia coli and Klebsiella pneumoniae. In New
      Zealand, the incidence of CPE has increased from three isolates in 2012 to 45 in 
      2016. The current epidemiology of CPE in New Zealand has similarities with the
      extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) epidemic 
      in the early 2000s (just before ESBL-PE underwent a non-linear increase in
      incidence). Although to date in New Zealand, nearly all CPE have been imported
      from overseas, this situation appears to be changing, with evidence of secondary 
      spread in both households and healthcare facilities over the last year. In this
      article, we argue that CPE should be regarded as the foremost AMR threat
      currently facing New Zealand, and highlight the need for a comprehensive national
      response plan, analogous to plans for other emerging transmissible infections,
      such as pandemic influenza and Ebola. We also make recommendations about the
      components of such a plan and advocate that CPE should be recognised as a key
      priority in New Zealand's national AMR strategy, due to be published in May 2017.
FAU - Blakiston, Matthew
AU  - Blakiston M
AD  - Microbiology Registrar, Auckland DHB.
FAU - Heffernan, Helen
AU  - Heffernan H
AD  - Scientist, Antibiotic Reference and Nosocomial Infections Laboratories, Institute
      of Environmental Science and Research Limited (ESR).
FAU - Roberts, Sally
AU  - Roberts S
AD  - Clinical Microbiologist, Auckland DHB.
FAU - Freeman, Joshua
AU  - Freeman J
AD  - Clinical Microbiologist, Auckland DHB.
LA  - eng
PT  - Journal Article
DEP - 20170428
PL  - New Zealand
TA  - N Z Med J
JT  - The New Zealand medical journal
JID - 0401067
RN  - 0 (Bacterial Proteins)
RN  - EC 3.5.2.6 (beta-Lactamases)
RN  - EC 3.5.2.6 (carbapenemase)
SB  - IM
MH  - Bacterial Proteins/*adverse effects
MH  - *Drug Resistance, Bacterial
MH  - Enterobacteriaceae/enzymology/*isolation & purification
MH  - Enterobacteriaceae Infections/*epidemiology
MH  - Health Knowledge, Attitudes, Practice
MH  - Humans
MH  - Microbial Sensitivity Tests
MH  - New Zealand
MH  - Practice Guidelines as Topic
MH  - *Travel
MH  - World Health Organization
MH  - beta-Lactamases/*adverse effects
COI - Nil.
EDAT- 2017/04/28 06:00
MHDA- 2017/05/04 06:00
CRDT- 2017/04/28 06:00
PST - epublish
SO  - N Z Med J. 2017 Apr 28;130(1454):72-79.

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