Management of carbapenem resistant organisms in a major burn centre

Dr Fangbo Lin1, Dr Rahul Jayakar1, Mr Richard Wong She1

1Middlemore Hospital, Auckland, New Zealand


Background: An increasing incidence of anti-microbial resistance has resulted in the emergence of Carbapenem resistant organisms (CRO). These have now become a major health crisis worldwide as they often result in infections that are challenging to manage. An outbreak of a carbapenemase-producing Enterobacteriaceae (CPE) in 2017 involving three patients in the New Zealand National Burn Centre (NBC) at Middlemore Hospital required the development and implementation of a protocol for management of CRO within the hospital. Since then a further six cases of CRO have been managed.

Aim: To document the prevelance of CRO in the National Burn unit; identify any risk factors; and outline our approach to the management of this complex problem.

Methods: We retrospectively reviewed all CRO positive microbiology samples isolated from patients under the care of the NBU from 2006 to 2019. Primary variables included specific organism, time to debridement, prior use of antibiotics and admission to an overseas hospital. We also reviewed hospital infection control practices to address a CRO outbreak.

Results: 26 CRO samples were isolated from 13 patients. 92% of these were from 2017 onwards.  Five patients were responsible for 17 cultured CPE organisms. Klebsiella pneumonia and pseudomonas aeruginosa were the most common organisms identified(27% each). Risk factors for could involve overseas hospital admission, exposure to CRO positive patients, and extended antibiotic use.

Conclusion: There has been a dramatic increase in the frequency of CRO identified in patients admitted to the NBU. Development of a multi-modal approach to isolation, protection and decontamination in theatre, ICU and wards had to be implemented to contain potential outbreaks.


A non-training surgical registrar from Auckland working in Middlemore Hospital with interest in Plastic Surgery.

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