Carbapenemase-producing Enterobacterales (CPE)

What does ‘Carbapenemase-producing Enterobacterales’ (CPE) mean?

Enterobacterales are bacteria that are normally present in the intestines and faeces and do not cause any harm there. This is called "colonisation".  

If bacteria get into the wrong places, such as the bladder or bloodstream, they can cause infections.

Carbapenems are a group of antibiotics. 

Carbapenemases are enzymes (chemicals) made by some strains of these bacteria that allow them to destroy carbapenem antibiotics, so the bacteria become resistant to these antibiotics.

These are called 'Carbapenemase-Producing Enterobacterales' or CPEs.

Why is carbapenem resistance important?

Carbapenems antibiotics are administered directly into the bloodstream typically in a hospital setting.

In the past, doctors have relied on this antibiotic group to successfully treat certain infections. Therefore, the spread of resistant bacteria can pose a problem in hospitals with large numbers of vulnerable patients.

Does CPE colonisation need to be treated the same as a blood stream infection?

If you are a carrier of CPE, no treatment is required. However, if bacteria do cause an infection, antibiotics are needed.

How is CPE spread?

If hospitalised patients carry CPE bacteria, these bacteria can enter the ward environment by different routes such as through direct physical contact.

So, washing hands after using the toilet and before meals is really important to stop CPE from spreading. 

How do we know if someone is colonised with CPE? 

It isn't usually known that a patient is CPE colonised until after a CPE test is performed to identify the bacteria.

Screening is undertaken:

• If the patient has been transferred from another hospital in the UK or abroad
• For patients hospitalized within the last 12 months
• If the patient is known to be colonised with CPE
• If the patient has been a known contact of someone with CPE colonisation and has had prolonged contact with the individual

How is CPE testing carried out?

A rectal swab is required for screening.

Rectal swabs are gently inserted directly into the rectum (anus) and removed with a twist. There may be some pressure as the swab is inserted into the rectum, but the test is usually painless.

Alternatively, you may be asked to provide a stool sample (stool sample). If you have a colostomy or stoma, swabs are also taken from this site at the same time.  

The swab will be sent to the laboratory and usually we will have the results within 2-3 days.

If the results are negative, no further action is necessary unless long-term hospitalisation is required. Further testing may be required as recommended by the infection control team.

Any patient who stays in the hospital for over 30 days will have another CPE test and this will be repeated at 30 day intervals to ensure that colonisation isn't missed. 

What if the result is positive?

Your doctor or nurse will explain your result further to you and give you an information leaflet to read. Staff will wear aprons and gloves when entering your room. No treatment is required unless you have an infection that requires antibiotics.

How can I prevent the spread of CPE?

Wash your hands with soap and water:

• After going to the toilet
• Before eating and drinking
• Before and after leaving your room or departments within the hospital

It’s important to maintain high levels of personal hygiene during your inpatient admission. This reduces the risk of developing or spreading lots of different infections. The nursing staff are able to assist with support with personal hygiene if you are struggling to complete this on your own. This includes wearing fresh clothes every day or changing clothing if it becomes soiled. 

It’s important that all patients and staff avoid sitting on patients beds. Patient should only sit or sleep in their own bed in the hospital to reduce the spread of micro-organisms. 

Laundry

If family or friends are washing your clothing while you are in hospital please advise them to wash the laundry separately from other clothing at 60°C.  

Can I have visitors during my admission if I have CPE?

Yes, you can have visitors. It’s advised that visitors wash their hands with soap and water when entering and exiting the room.

Aprons and gloves are not required for visitors to wear unless they are supporting with personal hygiene and care delivery. 

If your visitor is visiting another sick person in the hospital, ask them to visit you last.

What if someone is pregnant?

There are no additional risks to any individual who is pregnant when visiting a patient with this infection type. 

What should I do when I am discharged home?

It is advisable to continue to wash your hands with soap and water often, particularly after using the toilet and when preparing food.

Once you are discharged home, there are no activities restricted to you in the community due to you having a CPE positive result in hospital.  

  
For further information contact the Infection Prevention and Control Team on 07387546017.
 

This information has been reviewed by Cheshire and Merseyside Cancer Voices to check it is easy to understand. Cheshire and Merseyside Cancer Voices is a panel of cancer patients who volunteer to read NHS information to make sure it makes sense to people. They have been brought together by Cheshire and Merseyside Cancer Alliance.