BACKGROUND There has been an increase in the number of carbapenemase-producing organisms documented across the UK over the past 10 years. From these, the 'big five' carbapenemases (KPC, OXA-48, IMP, VIM, and NDM) are the most common types reported in the order Enterobacterales, identified from a variety of reactive screening, outbreak, inpatient surveillance, and diagnostic samples. AIM To perform a point prevalence study to determine the inpatient carriage rate of carbapenemase-producing organisms at Barts Health NHS Trust, which encompasses 2.5 million patients across four London boroughs: Tower Hamlets, Newham, Redbridge, and Waltham Forest. METHODS Rectal swabs were collected from consenting inpatients, alongside details of the ward's medical specialty, patient's country of birth, history of foreign travel, length of hospitalization, and history of prior hospitalization. Swabs were enriched and subcultured on to mSuperCARBA selective medium. All Enterobacterales, Acinetobacter, and Pseudomonas species were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectroscopy and underwent antibiotic susceptibility testing by disc diffusion, according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. All isolates were screened for the 'big five' carbapenemases using a modified version of a published reverse transcriptase-polymerase chain reaction assay. FINDINGS Of the 977 inpatients tested, 35 CPOs were isolated from 30 patients. NDM was the most frequently detected carbapenemase, followed by OXA-48, with an overall prevalence of 3.1%. Organisms isolated included Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, and Escherichia coli. Renal and elderly care patients had the highest prevalences of CPOs, whereas the intensive care unit prevalence was low. Statistical analysis found that hospitalization abroad, any previous hospitalization, foreign travel and, specifically, travel to India, Pakistan, and Bangladesh were associated with increased risk of CPO carriage. CONCLUSION The overall prevalence of CPOs at Barts Health Trust was 3.1%, comprising NDM and OXA-48-type carbapenemases, which is in line with other London-based studies. Renal patients and the elderly had the highest burden of CPOs, whereas previous hospitalization and foreign travel were associated with an increased risk of CPO carriage.

中文翻译：

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一项大型伦敦NHS信托基金的点流行度研究，用于确定产生碳青霉烯酶的生物体的住院率。

背景技术在过去的十年中，英国范围内记录的产生碳青霉烯酶的生物体的数量有所增加。从这些细菌中，“五种”碳青霉烯酶（KPC，OXA-48，IMP，VIM和NDM）是肠杆菌科中报告的最常见类型，可从各种反应性筛查，暴发，住院监测和诊断样本中鉴定出来。 。目的在Barts Health NHS Trust进行点流行度研究，以确定产生碳青霉烯酶的生物体的住院率，该研究范围包括伦敦四个行政区的250万患者：塔姆哈姆雷特，纽汉姆，雷德布里奇和沃尔瑟姆森林。方法：从同意的住院患者中收集直肠拭子，以及病房的医疗专业，患者的出生国家，出国旅行史，住院时间长短和以前的住院经历。将拭子富集并继代培养到mSuperCARBA选择性培养基上。根据欧洲抗菌药物敏感性试验委员会（EUCAST）指南，通过基质辅助激光解吸/电离飞行时间质谱仪鉴定了所有肠杆菌，不动杆菌和假单胞菌种类，并通过光盘扩散对其进行了药敏试验。使用已发布的逆转录酶-聚合酶链反应分析的改良版，对所有分离株的“大五”碳青霉烯酶进行了筛选。结果在977位住院患者中，从30位患者中分离出35位CPO。NDM是最常检测到的碳青霉烯酶，其次是OXA-48，总体患病率为3.1％。分离出的生物包括肺炎克雷伯菌，阴沟肠杆菌，变形杆菌和大肠杆菌。肾脏和老年护理患者的CPO患病率最高，而重症监护病房的患病率低。统计分析发现，国外住院，以前的任何住院经历，国外旅行，特别是到印度，巴基斯坦和孟加拉国的旅行，都与CPO运送风险增加有关。结论Barts Health Trust的CPO总体患病率为3.1％，包括NDM和OXA-48型碳青霉烯酶，与伦敦其他研究一致。肾病患者和老年人的CPO负担最大，而以前的住院和国外旅行与CPO运输的风险增加有关。肾脏和老年护理患者的CPO患病率最高，而重症监护病房的患病率低。统计分析发现，国外住院，以前的任何住院经历，国外旅行，特别是去印度，巴基斯坦和孟加拉国的旅行，都与CPO运送风险增加有关。结论Barts Health Trust的CPO总体患病率为3.1％，包括NDM和OXA-48型碳青霉烯酶，与伦敦其他研究一致。肾病患者和老年人的CPO负担最大，而以前的住院和国外旅行与CPO运输的风险增加有关。肾脏和老年护理患者的CPO患病率最高，而重症监护病房的患病率低。统计分析发现，国外住院，以前的任何住院经历，国外旅行，特别是到印度，巴基斯坦和孟加拉国的旅行，都与CPO运送风险增加有关。结论Barts Health Trust的CPO总体患病率为3.1％，包括NDM和OXA-48型碳青霉烯酶，与伦敦其他研究一致。肾病患者和老年人的CPO负担最大，而以前的住院和国外旅行与CPO运输的风险增加有关。具体来说，前往印度，巴基斯坦和孟加拉国的旅行与CPO运输的风险增加有关。结论Barts Health Trust的CPO总体患病率为3.1％，包括NDM和OXA-48型碳青霉烯酶，与伦敦其他研究一致。肾病患者和老年人的CPO负担最大，而以前的住院和国外旅行与CPO运输的风险增加有关。具体来说，前往印度，巴基斯坦和孟加拉国的旅行与CPO运输的风险增加有关。结论Barts Health Trust的CPO总体患病率为3.1％，包括NDM和OXA-48型碳青霉烯酶，与伦敦其他研究一致。肾病患者和老年人的CPO负担最大，而以前的住院和国外旅行与CPO运输的风险增加有关。