Carbapenemase-producing Enterobacterales (CPE)

What is CPE?

Enterobacterales is the name given to a type of bacteria or germs, many of which normally live in your bowel. A well-known member of Enterobacterales is Escherichia coli or E. coli.

Carbapenems are a group of antibiotics that usually work against these bacteria. However, some bacteria have become hard to treat because they have become resistant to these antibiotics. This means the antibiotics no longer work.

These antibiotic-resistant bacteria are called carbapenemase-producing Enterobacterales (CPE).

How do you get CPE?

Until recently, CPE bacteria were rare in Australia, but they are now found more often.

When people in Australia have CPE, they have often picked up the bacteria from having medical care overseas. CPE is found in patients in hospitals and clinics around the world, but particularly in Greece, India and South-East Asia.

It is also possible to pick up CPE in Australian hospitals.

Symptoms of CPE

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.

Anyone who has CPE, is considered to be colonised indefinitely. This means they can pass the CPE bacteria to others.

How does CPE spread?

CPE can spread in the following ways:

• Equipment that has been shared between healthcare patients.
• On people’s hands.
• Through contamination of the environment.

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

Will CPE make me unwell?

In most people, CPE does not cause illness. However, in some it can cause:

• serious illnesses – such as pneumonia)
• urinary tract infections (UTI)
• bloodstream infections.

Who is at risk of CPE?

CPE is more likely to cause illness in patients who have:

• a long stay in hospital
• admission to an intensive care unit (ICU)
• mechanical ventilation (breathing with a machine)
• multiple or recent exposures to broad spectrum antibiotics
• had recent surgery (especially on the prostate)
• an indwelling medical device (such as a urinary catheter or wound drain)
• an impaired immune system
• an organ or stem-cell transplant
• diabetes
• poor functional status.

Illness caused by CPE may occur the first time someone is exposed to CPE.

It may also happen in someone who is already colonised with CPE, especially if they experience any of the above listed health conditions or medical procedures.

How is CPE infection diagnosed?

If you have signs and symptoms of a CPE infection, your doctor may collect samples from you such as blood, urine or a wound swab.

These samples will be sent to a laboratory where they will be tested for bacteria including CPE. Your doctor will receive the results.

If the test shows you have CPE, your nurse or doctor will talk to you about the results and next steps.

Screening for CPE in health and residential care

Sometimes people who do not have signs or symptoms of CPE infection may be tested by a health or residential care facility to see if they are colonised with CPE. This is called screening.

With your consent, a nurse or doctor will take samples.

Screening for CPE may occur if you at risk of exposure to the infection – such as from previous overseas health care, or if you have had contact with someone who has CPE (for example, shared a room in a hospital).

The preferred method for CPE screening for is to test a sample of your faeces – although sometimes a rectal swab may be taken.

Also, if you have any wounds that have not yet healed or any indwelling medical devices (for example, a urinary catheter), samples may also be collected from these sites.

If you are found to be carrying CPE, your nurse or doctor will talk to you about the test results and what you can do to help prevent spread of the bacteria to other people.

While waiting for your test results, if you are in hospital, you may be placed in a single room. Staff entering the room will wear gowns and gloves in order to prevent passing CPE on to other patients.

How is CPE treated?

If you develop an infection caused by CPE, you may need treatment. There are not many options available as the bacteria is usually resistant to many antibiotics. However, some treatment options may exist, depending on the type of CPE you have.

Samples are sent to a laboratory to test the CPE bacteria against a range of antibiotics. This is to determine if any of them may be effective against the type of CPE causing your infection.

Your infection will be managed with advice from an infectious disease specialist. Your doctor will provide more specific information about any treatment you may need.

There is currently no evidence that CPE colonisation can be cured using antibiotics.

Treatment is 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 enough of the CPE bacteria that it is no longer detected on a test. However, this is not always the case – CPE may be present in very low numbers and come back if you are unwell or treated with antibiotics for other reasons. Because of this, people who carry CPE are considered to have indefinite colonisation, meaning they can pass it on to others.

What happens in health or residential care if I have CPE?

With any healthcare associated infection (or HAI), if you have an infection that may put others at risk, your treating team will need to take extra precautions.

To prevent the spread of CPE, in health and residential care facilities measures may include:

• You may be moved to a single room with a sign placed on your door. This is to remind staff who enter your room about the special precautions they need to take (such as wearing a gown and gloves).
• Everyone (including visitors and yourself) will need to wash their hands or use an alcohol-based hand rub before entering and leaving your room.
• An alert will be placed in your hospital record to staff. So, if you have future admissions extra precautions can be taken.

Visiting someone with CPE in hospitals

If you have CPE, your family and friends can visit you. However, to prevent the spread of CPE (and other infections), it is important that all visitors:

• Wash their hands or use an alcohol-based hand rub before entering and leaving your room.
• Do not eat or drink in your room.
• Do not use your hospital bathroom.
• Do not visit any other patients in the hospital immediately after visiting you.

Preventing the spread of CPE in hospitals

If you have been diagnosed with CPE, where possible:

• Avoid touching any areas of broken skin or wound dressings. If you need to, ensure you wash your hands or use an alcohol-based hand rub before and after doing so.
• Wash your hands or use an alcohol-based hand rub, particularly
  • After using the toilet.
  • Before eating food.
  • Whenever you leave your hospital room.

Any visitors you have in hospital should also continue to wash their hands or use alcohol-based hand rub before and after touching you or any items around your bedside.

Discharge from hospital for people with CPE

If you have CPE, and although you may be well enough to be discharged from hospital, you are still considered to have the infection.

Extra precautions will need to be taken each time you are admitted to a healthcare facility in the future.

If you go to another healthcare facility, healthcare provider (such as a doctor or physiotherapist) or have home care services in the future, you will need to tell them you have CPE. Take your hospital discharge summary with you.

Precautions at home for people with CPE

There is no need to take special precautions at home, but it is important your household follows these general hygiene practices:

• Always wash your hands with soap and water:
  • After going to the toilet.
  • Before preparing and eating food.
  • Before and after touching any wounds or medical devices that you may have.
• Use your own towels and face cloths. Do not share these items with other people.
• Cover any skin wounds whenever possible.

No special cleaning is required in your home. Your clothing may be laundered in the usual manner, along with the rest of the household laundry.

All eating utensils and dishes can be washed the way you normally do.

Remember to inform any health or residential care facilities or other healthcare providers that you have been found to have CPE.

There is no need to inform other community-based facilities or businesses that are not healthcare-related (for example, the public swimming pool).

Importantly, your access to treatment and care is not in any way affected by having CPE.

Where to get help

• Your GP or doctor
• Infectious disease specialist
• Your nursing staff
• Infection prevention and control team at your treating health or residential care facility