NHS study launched to tackle antimicrobial resistance threat

A new study will attempt to improve screening for one of the fastest-growing drug-resistant bacterial threats facing hospitals in England – carbapenemase-producing Enterobacterales (CPE) – which can spread rapidly in healthcare settings.

The 30-month, real-world TRACE-CPE study is being launched by the Fleming Initiative and diagnostics company Cepheid. It will compare rapid, molecular diagnostics for CPE, which can return a result in approximately one hour, against the current standard in the NHS of culture-based screening, which typically takes around 48 hours.

CPE has emerged as a serious antimicrobial resistance (AMR) problem worldwide, as they produce enzymes that destroy carbapenems like meropenem, imipenem, and ertapenem, which have become the last-line treatment for many multidrug-resistant (MDR) infections.

The group includes organisms, such as Escherichia coli and Klebsiella, that can live harmlessly in the gut of many patients, but can cause serious infections if they get into other parts of the body, such as the blood.

Reports of acquired carbapenemase-producing organisms in England more than doubled between 2021 and 2023, according to UK Health Security Agency (UKHSA) surveillance data.

Aside from the AMR issue, patients with CPE often have no symptoms, but can still transmit the infection, meaning it can spread undetected inside hospitals, leading to outbreaks, longer hospital stays, and higher mortality. In addition, once detected, measures to contain CPE often involve closure of medical facilities, disrupting care and placing considerable financial burden on the NHS.

One 10-month outbreak of the 'superbug' at an NHS hospital a few years ago cost around £1 million in missed revenue from elective surgeries, lab, and other resources used to screen patients, decontamination procedures, and extra staff time to manage the outbreak.

TRACE-CPE is evaluating how access to more rapid testing can affect clinical practice, infection control, and hospital transmission – modelling any potential cost benefits – and at the same time will look at risk factors and colonisation patterns to understand how CPE spreads within hospitals. It will be carried out at two of the hospitals run by Imperial College Healthcare NHS Trust and Guy's and St Thomas' NHS Foundation Trust.

The Fleming Initiative is backed by the UK government and pharma group GSK and is a central part of the UK's national action plan on AMR. Along with new drug and diagnostic development, a key part of its remit is finding strategies that can be deployed to tackle AMR at scale in health systems and keep the current antibiotic armamentarium working effectively.

"Antimicrobial resistance will not be addressed effectively by awareness alone. It will be solved by evidence, translated into practice, in the places where antibiotic decisions are actually made," said Dr Jonathan Otter, director of infection prevention and control at Guy's and St Thomas',​ who is principal investigator for the TRACE-CPE study.

"Our aim is a future where CPE does not spread in our hospitals, and rapid, accurate testing is central to making that future real."