049 Validation and application of new rapid laboratory diagnostic techniques to allow for the prevention, spread and transmission of carbapenem-resistant enterobacteriaceae (CRE) within a specialist paediatric hospital

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Background The Enterobacteriaceae are a genus of Gram-negative bacteria that have been implicated in human infections, such as pneumonia, septicaemia and urinary tract infections. Severe infections with this group of organisms are frequently treated with the Carbapenem class of antimicrobials. The increasingly frequent detection of Carbapanem-resistant Enterobacteriaceae (CRE) has impacted on the treatment of these infections and on patient outcomes. Management of patients with Enterobacteriaceae infections within the healthcare setting requires rapid, sensitive and specific detection of CRE as a laboratory diagnosis is the key component in determining clinical outcome. This is because detection leads to improved patient management and facilitates effective infection control interventions; which are key in the challenge to reduce the spread of CRE. Methods The current methods used to identify CRE are complex and only available at reference laboratories as they are usually based on molecular techniques. This leads to prolonged turnaround times and only permit provide retrospective confirmation of cross-transmission events A range of rapid phenotypic methods were studied to evaluate their use to decrease time to confirmation of CRE and thus improve patient management. The principle methods of which were: Bruker STAR-BL IMI kit in the identification of CPE, Multiplexed immunochromatography Lateral Flow assay versus the selective Carbasmart screening agar and ROSCO synergy confirmatory tests. Results The evaluation was undertaken with 103 enterobacterial isolates and 89 stool samples. The purpose of the study was to establish a simple, rapid and cost-effective test that provides specific and sensitive identification of CRE and the carbapenemase present in paediatric samples. Thus addressing the UK 5 year AMR strategy and GOSH Infection Prevention and Control (IPC) guideline for CRE.