Home' Australian Pharmacist : Australian Pharmacist Sept 2013 Contents Australian Pharmacist September 2013 I ©Pharmaceutical Society of Australia Ltd. 41
New treatment guidelines for
The emergence of highly drug-resistant superbugs resistant to all but a handful
of injectable and expensive antibiotics has led to Australian infectious diseases
experts, in conjunction with the Australian Federal Government, to publish
new draft treatment guidelines.
The guidelines were presented last month
during a session at Australasian Society
for Infectious Diseases (ASID) Gram
Negative 'Superbugs' Meeting on the
Gold Coast, by Associate Professor John
Ferguson, Director, Infection Prevention
& Control, Hunter New England Health,
NSW, on behalf of the Multidrug Resistant
Gram Negative Taskforce (MRNT),
Australian Commission on Safety and
Quality in Healthcare.
The emergence of carbapenem-resistant
Enterobacteriaceae (CRE) and their spread
across the world create special risks
for patients and potential challenges
for healthcare infection control. These
bacteria are resistant to carbapenem-
based antibiotics, and thus these
infections are only susceptible to a
handful of last-line, highly expensive
intravenous antibiotics. As such, they
are much harder to treat and have
higher mortality rates. In some cases, no
antibiotics at all are effective and in such
cases mortality is very high.
In 2012, the Australian Commission
on Safety and Quality in Healthcare
assembled an expert group to put
together prevention and control
recommendations, which included Assoc
Prof Ferguson, Professor David Paterson,
the University of Queensland Centre for
Clinical Research (UQCCR), and other
infectious diseases experts.
The expert group reviewed the evidence
and developed recommendations
across four topics: reducing community
and individual risk from CRE; detection
and surveillance of CRE; additional
control measures to reduce CRE
cross-transmission; and laboratory
They state that active screening for CRE is
recommended for the following patients:
patients directly transferred from any
overseas hospital (since many such
infections are contracted there, especially
in the Indian subcontinent); patients who
have been admitted overnight to any
overseas hospital or who have resided
in an overseas residential care facility
in the past 12 months; people who are
identified as a CRE contact during their
hospitalisation and have not been shown
to have negative post-contact cultures
(ie have tested positive or are yet to
have their results back as negative).
Patients with a previous history of CRE
colonisation or infection should also be
'All hospitals will have to implement
systematic questioning of patients at
triage or during the admission process,'
says Dr Ferguson. 'A national approach
to implementation will be considered.
Across Australia we already have some
standardisation of admission questioning
which we could build on.'
Dr Ferguson explains that virtually
all described types of carbapenem
resistance have been detected in
Australian patients including New Delhi
which has only been detected in patients
who have travelled from overseas.
IMP-4, a resistance gene similar in type
to NDM-1 is also transferrable amongst
Gram negative bacteria, some of which
are highly transmissible among patients.
Patients may develop septicaemia
or other serious infections with high
mortality. Both NDM-1 and IMP-4 are
genes that render various bacteria
such as Escherichia coli and Klebsiella
pneumoniae, resistant to carbapenem
and other penicillin-type antibiotics.
These genes are usually co-transferred
with other resistance genes that cause
the bacteria to be only susceptible to a
limited range of agents. Sporadic IMP-4
cases are detected in most jurisdictions
and outbreaks have been documented in
Sydney and Melbourne.
Assoc Prof Ferguson concludes:
'The Taskforce believes that
implementation of consistent Australian
CRE control measures at this early stage
is critical. If CRE is allowed to spread
unchecked, then the number of patients
with serious, including fatal, infection
due to CRE will increase. Subsequent
control measures will become much
more difficult than at present when CRE
detection is a relatively rare event.'
The final guidelines are expected to be
published later in 2013.
'All hospitals will
have to implement
patients at triage or
during the admission
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