Abstract：
Carbapenemase-producing Enterobacterales (CPE) cases increases every year in Denmark and the proportion of CPE-positive cases with a travel history decreases. Several epidemiological links show transmission in Danish healthcare setting indicating infection prevention and control challenges and raising questions about the Danish CPE screening protocol. The aim of this review was to identify additional risk factors to those described in the Danish CPE-screening protocol in order to detect the Danish CPE-positive patients and thereby reduce the risk of transmission and outbreaks. A systematic literature search was conducted in PubMed, Embase and Cochrane Library during March 2022. A total of 1487 articles were screened, and 19 studies were included. Retrieved studies dealt with patients with laboratory-confirmed CPE (colonization and/or infection) and associated risk factors. Antimicrobial therapy, especially broad-spectrum antimicrobial agents, prior or current hospitalization of approximately one week in ICU and 20-28 days in other wards and travel history with or without hospitalization abroad were significant risk factors associated with CPE acquisition. Comorbidities and invasive procedures were identified as risk factors, but without identifying specific comorbidities or invasive procedures associated with risk for CPE-acquisition. This study suggests the need to develop an additional algorithm for CPE-screening in Denmark. In addition to risk-based screening on admission, screening of inpatients should be considered. The screening protocol might include screening of inpatients with comorbidities who are hospitalized >1 week in ICU or >3 weeks in other wards and who have previously received or currently are receiving antibiotic treatment. Further research is needed to develop a new CPE-screening algorithm.
摘要：
在丹麦，产碳青霉烯酶肠杆菌（CPE）的病例每年都在增加，而有旅行史的CPE阳性病例的比例在下降。一些流行病学联系显示在丹麦医疗机构中的传播，表明感染预防和控制挑战，并引发了有关丹麦CPE筛查方案的疑问。本综述的目的是确定丹麦CPE筛查方案中描述的其他风险因素，以检测丹麦CPE阳性患者，从而降低传播和暴发的风险。在PubMed进行了系统的文献检索，Embase和Cochrane图书馆于2022年3月举行。共筛选1487篇,并纳入19项研究。检索到的研究涉及实验室确认的CPE（定植和/或感染）和相关危险因素的患者。抗菌治疗,尤其是广谱抗微生物剂，既往或目前在ICU住院约1周,在其他病房住院约20~28天,以及有或没有在国外住院的旅行史是与CPE获取相关的重要危险因素.合并症和侵入性手术被确定为危险因素，但没有确定与CPE获取风险相关的特定合并症或侵入性程序。这项研究表明，丹麦需要开发一种额外的CPE筛查算法。除了入院时基于风险的筛查，应考虑对住院患者进行筛查。筛查方案可能包括筛查在ICU住院>1周或在其他病房住院>3周并且先前接受或目前正在接受抗生素治疗的合并症住院患者。需要进一步研究以开发新的CPE筛选算法。
