New notifiable condition: carbapenemase-producing Enterobacterales
25 October 2019
Following a recent marked increase in the number of cases of people colonised or infected with carbapenemase-producing Enterobacterales (CPE) in South Australia, SA Health has made CPE a notifiable condition under the South Australian Public Health Act 2011, effective immediately and until further notice.
Enterobacterales is an order of Gram-negative bacteria which includes common gut organisms such as Enterobacter, Escherichia and Klebsiella. CPE are members of Enterobacterales that are resistant to most, or even all, types of antibiotics including Carbapenems and are considered to be a significant global health threat.
Diagnostic laboratories are required to:
- Notify all cases of CPE to the Communicable Disease Control Branch (CDCB), including suspected cases prior to confirmation from a reference laboratory.
- Advise the requesting doctor (e.g. via the testing report) that CPE, including suspected cases, must be notified to CDCB within 3 days, preferably sooner.
Doctors are required to:
- Notify all confirmed or suspected cases of CPE to CDCB within 3 days of receiving information from the laboratory.
Doctors are also advised to:
- Seek advice from an infectious diseases physician or clinical microbiologist regarding appropriate management of patients with CPE (either infected or colonised).
- Ensure transmission based precautions are in place if the patient is being managed in or to be transferred to a healthcare or residential care setting.
Carbapenems are a class of ‘last resort’ antibiotics including imipenem, meropenem, ertapenem and doripenem which are usually reserved for treating serious infections or when an infecting organism is resistant to commonly used antibiotics. The production of carbapenemase enzymes which inactivate these drugs means that this group of antibiotics and related cephalosporins and penicillins are no longer effective. Often no oral antimicrobial is available, and most patients will need to be hospitalised for intravenous therapy even for otherwise uncomplicated infections.
CPE have the ability to spread rapidly, and resistance genes are easily transferred between bacterial species. Patients can be colonised with CPE or develop serious infections including urinary tract, abdominal, bloodstream and respiratory infections, which are associated with high mortality rates. While many early infections in Australia were associated with imported cases, frequently linked to medical treatment overseas, CPE are now spreading within Australia. Last year, CPE were the most commonly identified bacteria with critical antimicrobial resistance in this country, making up >40% of all reports, with most cases reported from the eastern states. Cases are now increasing in South Australia (see Public Health Alert).
Further information is available at SA Health multidrug-resistant organisms (MRO) 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