Carbapenemase-producing Enterobacterales (CPE) health alert
11 September 2019
SA Health has been informed of a cluster of 10 cases of CPE in patients recently admitted to Flinders Medical Centre (FMC). The first case occurred in May 2019 followed by detection of sporadic cases suggestive of transmission between hospitalised patients at FMC. CPE is not a notifiable disease, however, a total of 21 cases of CPE have been detected in 2019, compared with 11 cases in 2018 and 5 cases in 2017.
Carbapenemase-producing Enterobacterales (formerly known as Enterobacteriaceae) are bacteria that are resistant to Carbapenem antibiotics (e.g. meropenem), a class of ‘last resort’ antibiotics for treating serious infections. CPE remains uncommon in Australia compared with Europe, North America, the Middle East and Asia. The first documented outbreak of CPE in Australia occurred in December 2012 and the number of CPE cases has continued to increase. To date South Australia has had minimal numbers of CPE cases, with most being associated with patients who have acquired CPE overseas or interstate.
CPE is transmitted via direct or indirect contact with a person with CPE, or from contaminated environmental surfaces or fomites. Patients can be colonised with CPE or develop serious infections including urinary tract, abdominal, bloodstream and respiratory infections, which may be fatal.
Healthcare practitioners can assist in reducing the risk of transmission of CPE through implementing existing infection prevention and control strategies including antimicrobial stewardship, standard precautions (including compliance with hand hygiene) and transmission based precautions as indicated.
Doctors with patients who have been identified as contacts of a patient with CPE are asked to:
- Perform CPE screening as per the advice in the FMC CPE contact letter or infection control alert. Take a faecal specimen or rectal swab, plus a groin swab. Request CRE screen on the pathology form.
- Manage the patient with standard and transmission based precautions (contact) whilst in a healthcare or residential care facility, pending results i.e. hand hygiene, environmental hygiene, isolation in a single room, use of personal protective equipment (gloves and gowns) and dedicated equipment.
Doctors with adult patients directly transferred from FMC (after a stay of at least 24 hours) to another hospital, healthcare or a residential care facility are asked to:
- Arrange a CPE screen via faecal specimen or rectal swab, plus a groin swab, on arrival at the receiving facility. Repeat at 7 days if the person remains an inpatient/resident.
- Manage the patient with standard precautions (unless the patient has additional transmission risk factors e.g . diarrhoea), whilst awaiting results.
Doctors with patients identified of having CPE colonisation or infection are asked to:
- Consider discussion with an infectious diseases physician or microbiologist, particularly to assist with managing infection.
- Manage patients in healthcare and residential care settings with transmission based precautions.
- Advise patients in general household settings of good hygiene measures including hand hygiene, using own towels and personal grooming items, and covering wounds to minimise the spread of CPE.
Further information is available at SA Health carbepenemase-producing enterobacterales (CPE) infection control web page.
For all enquires please contact the CDCB on 1300 232 272 (24 hours / 7 days)
Dr Louise Flood – Director, Communicable Disease Control Branch