Carbapenemase-producing Enterobacteriaceae (CPE) are emerging multidrug-resistant bacteria
Carbapenemase-producing Enterobacteriaceae (CPE) are gram-negative bacteria (e.g., Escherichia coli, Klebsiella sp.) that are resistant to most antibiotics, including meropenem, the most broad spectrum antibiotic.1 Incidence of CPE in Canada is increasing: from five cases in 2008 to 779 in 2016 (Dr. Michael Mulvey, National Microbiology Laboratory, Canadian Science Centre for Human and Animal Health, Winnipeg, Man.; personal communication, 2017), and outbreaks in hospitals have been reported.2 In 2017, the World Health Organization named CPE priority 1 pathogens.3
CPE is most commonly acquired in hospitals and long-term care facilities
Carbapenemase resistance is usually encoded by plasmids that can move between bacteria.1 Carbapenemase-producing Enterobacteriaceae reside in the gastrointestinal tract and are endemic in hospitals and long-term care facilities in many countries, including the United States.1 Patient-to-patient transmission occurs by contaminated hands of health care providers or contaminated shared patient equipment.2
CPE infection has similar clinical manifestations to those of other gram-negative bacteria
Infection caused by CPE will present with symptoms and signs typical of other gram-negative infections (e.g., urinary tract infection, sepsis).1 Colonization of CPE has no symptoms. In Canada, CPE are reliably identified from routine bacterial cultures or screening specimens (e.g., rectal swabs).
There are limited treatment options for CPE
Colonization does not require treatment.2 Antibiotic treatment options for CPE infection are limited at present and for the foreseeable future; last-line antibiotics (e.g., colistin) may be required.2 Mortality from bacteremia caused by CPE ranges from 25% to 50%;4 expert consultation should be sought for all CPE infections.
Preventing the spread of CPE requires multiple measures
Measures to prevent spread include requiring screening at-risk patients upon admission to hospital, providing care with gowns and gloves in a private room, meticulous hand hygiene, routine cleaning and disinfection of shared patient equipment, effective hospital cleaning and optimal antibiotic prescribing by physicians. 2,5 Alberta and British Columbia have made CPE a reportable disease, which may facilitate surveillance and timely interventions.
Footnotes
↵* PIDAC-IPC: Chingiz Amirov, Anne Bialachowski, Sandra Callery, William Ciccotelli, Maureen Cividino, Judy Dennis, Gary Garber, Susy Hota, Kevin Katz, Allison McGeer, Matthew Muller, Vydia Nankoosingh, Catherine Richard, Herveen Sachdeva, Mary Vearncombe
CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/170110-five
Competing interests: None declared.
This article has been peer reviewed.
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- There are limited treatment options for CPE
- Preventing the spread of CPE requires multiple measures
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