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peer-reviewed, Background Carbapenemase-producing Enterobacteriaceae (CPE) can cause healthcare–associated infections with high mortality rates. New Delhi metallo-beta-lactamase-1 (NDM-1) is amongst the most recently discovered carbapenemases. Aim To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures. Methods Retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE positive culture. Contacts were designated as roommates or ward mates. Findings This outbreak involved ten patients, with a median age of 71 years (range 45-90 years), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonised. Nine NDM-1-producing Klebsiella pneumoniae, a NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24 2014 and week 37 2014. Pulsed field gel electrophoresis demonstrated similarity. NDM-1 positive isolates were meropenem resistant with MICs ranging from 12 to 32 μg/ml. All were tigecycline susceptible (MICs ≤1 μg/ml). One isolate was colistin resistant (MIC 4.0 μg/ml; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected. Conclusions The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but a number had frequent hospitalisations in Ireland, raising concerns regarding the possibility of increasing but unrecognised prevalence of NDM-1 and potential decline in value of travel history a marker of colonisation risk., ACCEPTED, peer-reviewed

peer-reviewed, Letter to Editor, ACCEPTED, peer-reviewed

peer-reviewed, Contaminated blood cultures represent challenges regarding diagnosis, duration of hospitalization, antimicrobial use, pharmacy and laboratory costs. Facing problematic neonatal blood culture contamination (3.8%), we instigated a successful intervention combining skin antisepsis using sterile applicators with 2% chlorhexidine gluconate in 70% isopropanol prior to phlebotomy (replacing 70% isopropanol) and staff education. In the six months prior to intervention, 364 neonatal peripheral blood samples were collected. Fourteen (3.8%) were contaminated. In the post-intervention six months, 314 samples were collected. Three (0.96%) were contaminated, representing significant improvement (Fisher’s exact test: P= 0.0259). No dermatological sequelae were observed. The improvement has been sustained., ACCEPTED, peer-reviewed

peer-reviewed, Aim: To report the first Irish outbreak of cfr-mediated linezolid-resistant Staphylococcus epidermidis. Methods: Linezolid-resistant S. epidermidis isolated at University Hospital Limerick from four blood cultures, one wound and four screening swabs (from nine patients) between April and June 2013 were characterized by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and staphylococcal cassette chromosome (SCCmec) typing. Antibiotic susceptibilities were determined according to the guidelines of the British Society for Antimicrobial Chemotherapy. The outbreak was controlled through prohibiting prescription and use of linezolid, adherence to infection prevention and control practices, enhanced environmental cleaning, isolation of affected patients, and hospital-wide education programmes. Findings: PFGE showed that all nine isolates represented a single clonal strain. MLST showed that they belonged to ST2, and SCCmec typing showed that they encoded a variant of SCCmecIII. All nine isolates were cfr positive, and eight isolates were positive for the G2576T 23S rRNA mutation commonly associated with linezolid resistance. Isolates exhibited multiple antibiotic resistances (i.e. linezolid, gentamicin, methicillin, clindamycin, ciprofloxacin, fusidic acid and rifampicin). The adopted infection prevention intervention was effective, and the outbreak was limited to the affected intensive care unit., PUBLISHED, peer-reviewed

peer-reviewed, In the context of the excellent report of successful control of an outbreak of carbapenemase-producing Klebsiella pneumoniae in an Italian neonatal intensive care unit published in this journal (1), we wish to report the consequences of the first outbreak of KPC-producing Kliebsiella in Ireland and how, despite identification of operational factors associated with the incidence and best efforts towards rectifying those, our 410-bed hospital in the West of Ireland is failing to control endemic KPCs. Globally, there is recognition of the significant morbidity and mortality implications associated with emergence of carbapenemase-producing bacteria (2). The resulting vigilance has resulted in enhanced reporting of outbreaks, many being the first of their kind in specific countries (3), and descriptions of molecular studies to determine incidence and transfer of the carbapenemase-encoding blaKPC-harboring IncFIA plasmid between clonal variants (4). With indicative rates of carriage being circa 20%, infection control specialists are reacting with novel techniques for microbiological detection, strategies for prevention of nosocomial transmission, and clinical microbiologists are facing therapeutic challenges related to limited, relatively unproven antimicrobial treatment options., ACCEPTED, peer-reviewed