Search and contain : impact of an integrated genomic and epidemiological surveillance and response program for control of carbapenemase-producing Enterobacterales

Funding: This work was supported by the National Health and Medical Research Council through a partnership grant (grant number GNT1149991) and individual supporting grants (grant numbers GNT1142613 [to J. C. K.], GNT1123854 [to D. A. W.], GNT1105905 [to B. P. H.], GNT1141398 to [A. J. S]); N. L. S. and C. R. L. are supported by Australian Government Research Training Program scholarships and the Microbiological Diagnostic Unit Public Health Laboratory is funded by the Victorian Government.Background Multiresistant organisms (MROs) pose a critical threat to public health. Population-based programs for control of MROs such as carbapenemase-producing Enterobacterales (CPE) have emerged and evaluation is needed. We assessed the feasibility and impact of a statewide CPE surveillance and response program deployed across Victoria, Australia (population 6.5 million). Methods A prospective multimodal intervention including active screening, carrier isolation, centralized case investigation, and comparative pathogen genomics was implemented. We analyzed trends in CPE incidence and clinical presentation, risk factors, and local transmission over the program’s first 3 years (2016–2018). Results CPE case ascertainment increased over the study period to 1.42 cases/100 000 population, linked to increased screening without a concomitant rise in active clinical infections (0.45–0.60 infections/100 000 population, P = .640). KPC-2 infection decreased from 0.29 infections/100 000 population prior to intervention to 0.03 infections/100 000 population in 2018 (P = .003). Comprehensive case investigation identified instances of overseas community acquisition. Median time between isolate referral and genomic and epidemiological assessment for local transmission was 11 days (IQR, 9–14). Prospective surveillance identified numerous small transmission networks (median, 2; range, 1–19 cases), predominantly IMP and KPC, with median pairwise distance of 8 (IQR, 4–13) single nucleotide polymorphisms; low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted response. Conclusions We demonstrate the value of centralized CPE control programs to increase case ascertainment, resolve risk factors, and identify local transmission through prospective genomic and epidemiological surveillance; methodologies are transferable to low-prevalence settings and MROs globally.Peer reviewe

Search and Contain: Impact of an Integrated Genomic and Epidemiological Surveillance and Response Program for Control of Carbapenemase-producing Enterobacterales

BACKGROUND: Multiresistant organisms (MROs) pose a critical threat to public health. Population-based programs for control of MROs such as carbapenemase-producing Enterobacterales (CPE) have emerged and evaluation is needed. We assessed the feasibility and impact of a statewide CPE surveillance and response program deployed across Victoria, Australia (population 6.5 million). METHODS: A prospective multimodal intervention including active screening, carrier isolation, centralized case investigation, and comparative pathogen genomics was implemented. We analyzed trends in CPE incidence and clinical presentation, risk factors, and local transmission over the program's first 3 years (2016-2018). RESULTS: CPE case ascertainment increased over the study period to 1.42 cases/100 000 population, linked to increased screening without a concomitant rise in active clinical infections (0.45-0.60 infections/100 000 population, P = .640). KPC-2 infection decreased from 0.29 infections/100 000 population prior to intervention to 0.03 infections/100 000 population in 2018 (P = .003). Comprehensive case investigation identified instances of overseas community acquisition. Median time between isolate referral and genomic and epidemiological assessment for local transmission was 11 days (IQR, 9-14). Prospective surveillance identified numerous small transmission networks (median, 2; range, 1-19 cases), predominantly IMP and KPC, with median pairwise distance of 8 (IQR, 4-13) single nucleotide polymorphisms; low diversity between clusters of the same sequence type suggested genomic cluster definitions alone are insufficient for targeted response. CONCLUSIONS: We demonstrate the value of centralized CPE control programs to increase case ascertainment, resolve risk factors, and identify local transmission through prospective genomic and epidemiological surveillance; methodologies are transferable to low-prevalence settings and MROs globally

Requirements, in terms of root canal treatment, of undergraduates in the European Union: an audit of teaching practice

Aim The purpose of this study was to gather information from across the EU about requirements of dental undergraduates in the area of root canal treatment (RCT). Methodology One hundred and ninety-two EU dental schools were invited to complete an online survey. The survey inquired about assessment in RCT, whether students complete a minimum number of RCTs, whether this includes both anterior and posterior teeth, and if root canal retreatment and endodontic surgery are compulsory. The final question asked how competence in RCT can be described. Results Forty-eight dental schools in 20 countries responded. Results showed variation in assessment methods. Ninety-four percent insist on students performing RCT in anterior and posterior teeth. Eighty-one percent ensure students perform a minimum number and there is considerable variation in what that minimum number is. Seventy-nine percent require undergraduates to perform retreatment and 4% require them to perform endodontic surgery. Descriptions of what might constitute competence in RCT varied greatly. Conclusions Despite convergence of the undergraduate curriculum being endorsed by many and movement of dentists within the EU escalating, there is still inconsistency in the output of dental schools with regard to RCT. This sample demonstrated deviation from the ESE's 2001 Undergraduate Curriculum Guidelines for Endodontology