Carbapenemase-producing Enterobacterales - including symptoms treatment and prevention

Enterobacterales are a group of bacteria that normally live in the bowel (gut).

Carbapenemase-producing Enterobacterales (CPE) are bacteria of this group that are especially resistant to usual and highly effective antibiotics. CPE infections can be harder to treat.

CPE is a notifiable condition1

How CPE is spread

CPE lives in the bowel and can be present on the skin. CPE can spread in the following ways:

  • Through equipment that has been shared between healthcare patients.
  • Directly from person to person by unwashed hands.
  • Through contamination of the environment.

It is not spread through the air by coughing or sneezing.

Risk factors for CPE

You may have an increased risk of CPE if you:

  • Have had a recent long hospital admission.
  • Have had a recent intensive care admission.
  • Have received medical care overseas.
  • Have been in a hospital where there were other patients with CPE.
  • Received chemotherapy in a hospital the last 12 months.
  • Have an indwelling medical device (such as a catheter).
  • Have had an organ or stem cell transplant.
  • Have diabetes.
  • Had CPE in the past.

Signs and symptoms

In most cases, CPE lives in people’s gut or elsewhere on their body without causing any symptoms or infection. When bacteria live harmlessly in a person, this is known as colonisation or “carrying” CPE.People who have CPE may carry CPE for months to years.

“Carrying” CPE in your body is different from having an infection caused by CPE. However, in some people, CPE can it can cause:

  • Serious illnesses – such as pneumonia (infection of the lung).
  • Urinary tract infections (UTI).
  • Bloodstream infections.

People with CPE colonisation or infection can pass/ spread the CPE bacteria to other people.

Prevention

Are there any special precautions that I need to do if I have CPE?

Generally, there is no need to take special precautions at home except for general hygiene practices including:

  • Wash your hands with soap and water after going to the toilet, before preparing and eating food, and before and after touching any wounds or medical devices
  • Cover any skin wounds where possible
  • Avoid sharing personal care items

If you are in a hospital or other health care setting, your healthcare team may use specific precautions to reduce the risk of spreading CPE to other patients. These may include:

  • Caring for you in a single room or designated area with your own toilet.
  • Wearing a gown and gloves while they are caring for you.
  • Frequently cleaning your room, bathroom, and medical equipment.
  • Using signage to let others know to take precautions.
  • Placing an alert on your medical records.

You can help prevent spreading CPE to other patients and your visitors by:

  • Regularly washing your hands with soap and water, or using an alcohol-based hand rub.
  • Avoid using communal areas such as shared bathrooms and kitchens and staying in your room unless you are moved for tests or treatment. Follow the advice of your healthcare provider.

Diagnosis

If you have symptoms of infection your doctor may decide to test you for CPE.

They may collect a blood, faeces (poo) or urine sample or take a wound swab.

Screening means testing people to see if they carry CPE, even if they don’t have symptoms.

You may be offered screening if you are at higher risk of carrying CPE. This is usually done with a faecal (poo) sample or a rectal swab.

Treatment

Treatment is generally not required or recommended for people found to be colonised with CPE without any signs or symptoms of an infection.

Over time, your body may clear the CPE bacteria that it is no longer detected on a test. However, CPE may be present in very low numbers and may be detected if you are unwell or treated with antibiotics, so it is important to let your health care provider know about previous CPE.

CPE infections are treated with the same principles as other infections. Because they are more resistant to antibiotics, the choice of antibiotic used may be different. Your doctor may ask for advice from an infectious diseases specialist to treat a CPE infection.

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