Carbapenem-producing enterobacteriaceae

The incidence of carbapenem-producing enterobacteriaceae (CRE) is increasing worldwide.

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About CPE

Enterobacteriaceae are a large and diverse family of gram-negative bacteria and, although they generally exist as commensal organisms in the human gastrointestinal tract, they can be responsible for a variety of infections, including; urinary tract infections, wound infections, gastroenteritis, meningitis, septicaemia, and pneumonia. Amongst the gram-negative bacteria, the Enterobacteriaceae are the most frequent cause of both community-acquired and healthcare-acquired infections.

Carbapenem-resistant Enterobacteriaceae (CRE) are Enterobacteriaceae that are non-susceptible to carbapenem antibiotics. CPE are defined as any of the CRE that harbour a gene encoding carbapenemase (a β-lactamase). CPE are often also resistant to many other classes of antimicrobial agents.

How it is spread

While the majority of cases of infection or colonisation by CPE are detected via active surveillance at admission to healthcare facilities, there is international evidence of an increasing trend of community carriers, particularly in areas where it is endemic such as the Indian Subcontinent, where there is a particularly high prevalence in India and Pakistan.

CPE have spread rapidly due to global movements, medical tourism and through transmission of plasmids carrying the gene from one bacterium to another. Sporadic cases of colonised or infected patients have been reported in a range of countries across most continents. Typically, these patients have recently received healthcare in a high CPE burden country.

Spread within health care settings has been well described in high, middle and low income countries.

New Zealand situation

In New Zealand, the rate of CPE carriage and infection has increased sharply in recent years, and while until very recently nearly all CPE have been imported from overseas, however, we are now seeing carriers in the community and transmission in healthcare facilities.

Year Number of cases
Table 1.1 – No. of people per year identified having a positive CPE isolate
2009 - 2014 30
2015 29
2016 38
2017 33
2018 – Sept 2018 54

Minimising the effects of CPE

Health care facilities in New Zealand need to take a proactive approach to ensure strong measures are in place to minimise the effect of these resistant organisms.

Awareness, education, early identification, and infection prevention and control measures are key elements to reduce the spread and transmission of CPE which carry a high mortality and may be completely resistant to antibiotics.

Please ensure that your health care facility has up-to-date policies and procedures in place to identify and manage CPE. Critical policies and procedures include:

  • screening policies to identify patients at high-risk for colonisation/infection with a CPE
  • standard and transmission-based (contact precautions) precautions for all suspected or laboratory-confirmed cases of CPE
  • hand hygiene policy
  • laboratory procedures in place to detect and report CPE 
  • alerting other health care facilities that the patient is colonised or infected with a CPE though the National Medical Warning System.
  • infection prevention and control measures (eg, cleaning and disinfection procedure)
  • antimicrobial stewardship programmes.

Contact your local Infection Prevention and Control teams for further advice and education as needed.

Suspected or confirmed cases

In the event of a suspected/confirmed CPE case, contact your local Infection Prevention and Control, Infectious Diseases and Clinical Microbiology Services.

Further information

New Zealand’s “Infection Prevention & Control and Management of Carbapenemase-producing Enterobacteriaceae (CPE) Guidelines for Healthcare Providers in New Zealand” are due to be released end of October 2018

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Related websites

New Zealand’s “Infection Prevention & Control and Management of Carbapenemase-producing Enterobacteriaceae (CPE) Guidelines for Healthcare Providers in New Zealand” are due to be released end of October 2018.

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