What are Carbapenemase; Producing Enterobacterales (CPE)?
CPE are bacteria that are members of the family Enterobacterales that are identified as carrying a carbapenemase gene. Enterobacterales are the largest family of gram-negative bacteria causing human infection.
Everyone has bacteria that live in the bowel that are generally harmless and can even help with digestion and general health. Your immune system keeps them in check and prevents them from spreading elsewhere in the body. However, sometimes these bacteria can cause infections and in certain situations they are antibiotic-resistant (this is where certain antibiotics no longer work against bacteria).
Some of these bugs have become CPE as they have become resistant to multiple antibiotics including the carbapenem antibiotics. These CPE are common in many overseas countries but are rare in New Zealand. There are very few antibiotics which can treat infections caused by these organisms, and in extreme cases no antibiotics are effective.
The majority of patients who are found to have CPE do not have symptoms and are known as carriers. If, however, a person develops an infection (such as urinary tract or bloodstream) for whatever reason and carries the CPE organism, then that organism may be involved in that infection.
How do people get CPE?
CPE are more common in some countries than others. They are rare in New Zealand and currently almost all new isolates have been associated with foreign travel or residency.
Widespread use of antibiotics has caused the development of resistant bacteria such as CPE. CPE can spread between people through direct contact with each other or by touching items or surfaces that the person with CPE may have touched such as bed rails, toilets or equipment. As patients in hospital are much more vulnerable to infection, special precautions are taken to prevent the spread of CPE between them.
How could I have picked up CPE in New Zealand?
You may have attended hospital at the same time as a person who is a carrier or been overseas. CPE can be spread between people via direct contact with each other or through indirect contact with objects like touching toilets, bed rails, door knobs and other equipment at the hospital.
Is it easy to identify the symptoms of CPE?
No, the majority of people who are found to have CPE do not have symptoms and are known as carriers. Rarely, CPE can cause symptomatic infections such as urine, kidney or bloodstream infections in patients (such as critically unwell patients), and patients needing intensive care or while receiving chemotherapy.
Which patients are routinely tested for CPE?
CPE is a common bug in some overseas countries. If a patient has travelled to another country (except Australia) or been admitted to hospital in another country in the past 12 months and is being admitted to hospital in New Zealand, they should tell their doctor or nurse so that a CPE test can be done if deemed necessary.
How is the test done?
A faeces sample of swab of faeces taken from a patient’s rectum is the quickest and easiest way to check for CPE, as it is usually detected in the bowel. The swab will be put in a special sample container to send to the hospital laboratory.
What is the risk associated with CPE?
As mentioned above, people who have acquired CPE usually just ‘carry’ it in their gut and suffer no consequences. However, if these people develop an infection for any reason then it is possible the CPE may be involved. The main risk is to vulnerable patients while they are in hospital.
Again, CPE in NZ is very rare and the approaches taken with increased hygiene precautions and the use of gowns and gloves and vigilant hand cleaning are designed to prevent CPE getting a toe-hold in NZ and NZ hospitals. The risk to members of the public is still tiny but as a general measure good hygiene practices are advised while visiting patients in hospital.
What do I need to do to prevent the spread of CPE?
CPE is spread by contact so the best way to prevent the spread of CPE is to ensure that you maintain a strict approach to hygiene. This means washing your hands thoroughly at all times.
If I want to talk to someone, who can I call?
If you have any questions and want to talk to a nurse, please contact us through Healthline on 0800 611 116.