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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 health care-acquired infections.
Carbapenem-resistant Enterobacteriaceae (CRE) are Enterobacteriaceae that are non-susceptible to carbapenem antibiotics.
Carbapenemase-producing Enterobacteriaceae (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 spreads
While the majority of cases of infection or colonisation by CPE are detected via active surveillance at admission to health care 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 health care 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 health care facilities.
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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.
It is important that the Ministry is informed of any actual or suspected CPE transmissions as soon as possible after such transmissions have been identified.
This should be notified via email to firstname.lastname@example.org
On this website:
Infection Prevention & Control and Management of Carbapenemase-producing Enterobacteriaceae (CPE) Guidelines for Health care Providers in New Zealand Acute and Residential Care Facilities
- Antimicrobial resistance
- Public Health Surveillance (ESR): Acquired carbapenemases in Enterobacterales and Pseudomonas aeruginosa
- Australian Commission on safety and Quality in Health Care: Recommendations for the control of Carbapenemase-producing Enterobacteriaceae
- Health.vic (Victoria State Government): Guidelines on carbapenemase-producing Enterobacteriaceae management
- European Centre for Disease Prevention and Control: Carbapenem-resistant Enterobacteriaceae (CRE).