Changes in isolation guidelines for CPE patients results in only mild reduction in required hospital beds

Michael J Lydeamore; David Wu; Tjibbe Donker; Claire Gorrie; Charlie K Higgs; Marion Easton; Daneeta Hennessy; Nicholas Geard; Benjamin P Howden; Ben S Cooper; Andrew Wilson; Anton Y Peleg; Andrew J Stewardson

doi:10.1016/j.idh.2024.10.004

Changes in isolation guidelines for CPE patients results in only mild reduction in required hospital beds

Infect Dis Health. 2024 Nov 24:S2468-0451(24)00114-7. doi: 10.1016/j.idh.2024.10.004. Online ahead of print.

Authors

Affiliations

¹ Department of Econometrics and Business Statistics, Monash University, Clayton, VIC, Australia; Victorian Department of Health, Government of Victoria, Melbourne, VIC, Australia. Electronic address: [email protected].
² Department of Econometrics and Business Statistics, Monash University, Clayton, VIC, Australia.
³ Institute for Infection Prevention and Hospital Epidemiology, University Medical Center Freiburg, Germany.
⁴ Department of Microbiology & Immunology, University of Melbourne, At the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, At the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
⁵ Department of Microbiology & Immunology, University of Melbourne, At the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
⁶ Victorian Department of Health, Government of Victoria, Melbourne, VIC, Australia.
⁷ School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, VIC, Australia.
⁸ Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne, At the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
⁹ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom.
¹⁰ Department of Infectious Diseases, The Alfred and School of Translational Medicine, Monash University, Melbourne, VIC, Australia; Infection Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Melbourne, VIC, Australia; Centre to Impact AMR, Monash University, Melbourne, VIC, Australia.
¹¹ Department of Infectious Diseases, The Alfred and School of Translational Medicine, Monash University, Melbourne, VIC, Australia.

PMID: 39586760
DOI: 10.1016/j.idh.2024.10.004

Abstract

Background: Carbapenemase-producing Enterobacterales (CPE) are an emerging public health concern globally as they are resistant to a broad spectrum of antibiotics. Colonisation with CPE typically requires patients to be managed under 'contact precautions', which creates additional physical bed demands in healthcare facilities.

Methods: This study examined the potential impact of revised isolation guidelines introduced in late 2023 in Victoria, Australia, that relaxed the requirement for indefinite isolation of CPE-colonised patients in contact precautions, based on admission of CPE-diagnosed cases prior to the guideline change.

Results & conclusions: Our analysis showed that while the changes result in modest savings in the need for dedicated isolation rooms, they could reduce the duration of time individual patients spend in isolation by up to three weeks. However, ongoing investments to expand isolation capacity would still be required to accommodate the rising incidence of CPE.

Keywords: Antimicrobial resistance; Carbapenemase-producing enterobacterales; Clearance; Transmission-based precautions.