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Infections due to CPE are associated with higher in-hospital mortality

About

• Escherichia coli (E. coli) and Klebsiella pneumoniae are the most commonly encountered CPE.
• Other genera include Enterobacter, Serratia, and Proteus.

Aetiology

• Carbapenemases: Enzymes that break down carbapenem antibiotics, leading to resistance.
• Klebsiella pneumoniae carbapenemase (KPC): One of the most common and widespread carbapenemases globally.
• New Delhi metallo-β-lactamase (NDM): A metallo-β-lactamase that hydrolyzes a wide range of β-lactam antibiotics.
• Verona integron-encoded metallo-β-lactamase (VIM) and Imipenemase (IMP): Other metallo-β-lactamases.
• Oxacillinase-48 (OXA-48): A carbapenemase primarily found in Europe and the Middle East.

Clinical

• Infections: CPE can cause infections such as urinary tract infections, sepsis, pneumonia, and intra-abdominal infections.
• Treatment Challenges: The resistance to most β-lactam antibiotics, including carbapenems, limits treatment options. Often, older antibiotics with more severe side effects, such as colistin, tigecycline, or aminoglycosides, are used.

Transmission

• Healthcare Settings: CPE are primarily spread in hospitals and long-term care facilities via contaminated surfaces, medical equipment, or healthcare workers' hands.
• Colonization vs. Infection: Individuals can be asymptomatic carriers and still spread the bacteria to others, with a risk of developing infections later, especially if they become immunocompromised.

Those with organism

• Staff must be alert to the increased risk of infection or colonisation with patient transfers/admissions from high-risk overseas countries, including Bangladesh, the Balkans, China, Cyprus, Greece, India, Ireland, Israel, Italy, Japan, North Africa (all), Malta, the Middle East (all), Pakistan, South East Asia, South/Central America, Taiwan, Turkey and the USA. This list is not exhaustive and transfers from any hospital abroad should be risk assessed

Risk Assessment

• Is the patient a laboratory-confirmed case of carbapenemase-producing Enterobacteriaceae infection/colonisation, during this admission an episode or at a transferring healthcare facility?
• Has the patient in the last 12 months been an inpatient in a hospital abroad or known to have been in a UK hospital with known infection or been colonised with or been in close contact with the organism

Investigations

• Laboratory Testing: Detection involves specialized microbiological techniques, including:
• Molecular methods: PCR testing to detect specific carbapenemase genes (e.g., KPC, NDM, VIM, OXA-48).
• Phenotypic methods: Tests that assess the bacteria's resistance to carbapenems, such as the modified Hodge test or Carba NP test.

Management

• If they are at risk as defined then isolate the patient immediately into a side room with en-suite facilitates. Instigate strict infection control standard precautions to prevent the possible spread
• Screen to assess current status for colonisation or infection and assessment for appropriate treatment (applies to infection only). Alert the IP&CT
• If the patient is POSITIVE on screening for carbapenemase-producing Enterobacteriaceae or is a laboratory-confirmed case (colonisation or infection) they should remain in isolation for the duration of their hospital stay
• Treatment of the patient with an infection caused by carbapenemase-producing Enterobacteriaceae should be under the advice of the microbiologist

References

• European policy
• Policy document