Counties Manukau Health contacting patients following rare multi-drug resistant organism case

Counties Manukau Health is contacting approximately 200 Haematology Day Stay patients who may have come into contact with a patient who has tested positive for a multi-drug resistant organism.

On admission to a ward at Middlemore Hospital recently, the patient was identified as carrying a multi-drug resistant organism - carbapenem-resistant organism – commonly referred to as CRO. (Carbapenems are a powerful group of antibiotics often relied on for infections when treatment with other antibiotics are ineffective.)

David Holland, Infectious Diseases Consultant, says the patient had previously attended Haematology Day Stay at the hospital during the period between 6 March and 5 July this year and may have come into indirect contact with approximately 200 other day stay patients. 

“We are following a pragmatic process for this and are contacting all 200 patients who attended the day stay, to talk to them about CRO,” says Dr Holland.

“While there is only a very small risk that they may have acquired this organism, we are taking a precautionary approach to ensure that those who may have come into contact with the patient are checked and we can rule out any possibility that they have CRO,” says Dr Holland.

“The screening involves a simple procedure where we will take a rectal swab.  We will have the results from the test within a few days but it will take some time to collate all of the results and advise everyone. 

“Approximately 400 patients who attended the day stay during the same period, but not necessarily the same day as the patient with CRO, will also be contacted as part of our process, and screening arranged with them.”

Dr Holland emphasises that the finding of this organism does not raise concerns for most patients or the visiting public.

“We have measures in place designed to manage and prevent the spread of CRO and the majority of patients and the visiting public are not at any risk. Patient safety is paramount and that is why we are taking the extra step of informing and screening to ensure that the organism is contained and managed.”

Haematology day patients who want to talk to a nurse about CRO can contact the Healthline on 0800 611 116.

General Q&A – Carbapenem Resistant Organisms (CRO)

What are Carbapenem Resistant Organisms (CRO)?

Everyone has bacteria that live in the bowel that are generally harmless and can even help with digestion and general health. Your immune system keeps them in check and prevents them from spreading elsewhere in the body. However, sometimes these bacteria can cause infections and in certain situations they are antibiotic-resistant (this is where certain antibiotics no longer work against bacteria).

Some of these bugs have become Carbapenem Resistant Organisms (CRO) as they have become resistant to multiple antibiotics including the carbapenem antibiotics, These CROs are common in many overseas countries but are rare in New Zealand. There are very few antibiotics which can treat infections with CRO, and in extreme cases no antibiotics are effective.

The majority of patients who are found to have CRO do not have symptoms and are known as carriers. If, however, a person develops an infection (such as urinary tract or bloodstream) for whatever reason and carries the CRO organism, then that organism may be involved in that infection.

How do people get CRO?

CRO are more common in some countries than others. They are rare in New Zealand and currently almost all new isolates have been associated with foreign travel.

Widespread use of antibiotics has caused the development of resistant bacteria such as CRO. CRO can spread between people through direct contact with each other or by touching items or surfaces that the person with CRO may have touched such as bed rails, toilets or equipment. As patients in hospital are much more vulnerable to infection, special precautions are taken to prevent the spread of CRO between them.

Which patients are tested for CRO?

CRO is a common bug in some countries. If a patient has been admitted to hospital in another country in the past 12 months and is being admitted to hospital in New Zealand, they should tell their doctor or nurse so that a CRO test can be done if deemed necessary.

How is the test done?

A swab taken from a patient’s rectum is the quickest and easiest way to check for CRO, as it is usually detected in the bowel. The swab will be put in a special sample container to send to the hospital laboratory.

The hospital laboratory will usually be able to rule out CRO within 3 days.

What is the risk associated with CRO?

As mentioned above, people who have acquired CRO usually just ‘carry’ it in their gut and suffer no consequences. However, if these people develop an infection for some reason then the CRO may be involved. The main risk is to vulnerable patients while they are in hospital.

Again, CRO in NZ is very rare and the approaches taken with increased hygiene precautions and the use of gowns and gloves and vigilant hand cleaning are designed to prevent CRO getting a toe-hold in NZ and NZ hospitals. The risk to members of the public is tiny but as a general measure good hygiene practices are advised while visiting patients in hospital.

How do I make an appointment for a check-up?

Patients who have attended the day stay will be contacted by Counties Manukau Health to arrange an appointment for screening. This will involve a simple procedure where we will take a rectal swab.  We will also follow up with a phone call or letter to advise your results.

If I want to talk to someone, who can I call?

If you have any questions and want to talk to a nurse, please contact us through Healthline on 0800 611 116.