Carbapenemase-producing Enterobacteriaceae (CPE)

What are CPE?

Enterobacteriaceae are a family of bacteria, many of which live in our gastrointestinal tract or bowels. Carbapenemase-producing Enterobacteriaceae (CPE) produce carbapenemase enzymes that can break down most types of antibiotics, making the antibiotics less effective. As a result, infections caused by these bacteria can be very resistant and difficult to treat.

Does CPE go away?

People who have CPE in their bowel will likely carry it for a long time. Your child may be treated if CPE causes symptoms of infection for them.

Who is at risk for CPE?

Currently, the most common risk factor is receiving health care in settings that have CPE, such as hospitals along the U.S. eastern seaboard (particularly New York City), Europe (particularly Romania, Denmark, Spain, Hungary, Italy and Greece), Israel and the Indian subcontinent (particularly India, Pakistan and Bangladesh). CPE outbreaks have been seen in hospitals around the world, including Canada. People coming from the Indian subcontinent, with or without exposure to health care, are also at risk.

How are CPE spread?

Most people who carry CPE have no symptoms of infection and are said to be colonized. The main site of colonization of CPE is the bowel. CPE is not spread through the air but may survive on equipment and surfaces, such as bedrails, tables, chairs, countertops and door handles. CPE can spread from one person to another by unwashed hands or from contact with soiled equipment and surfaces. Infections can occur if CPE enters a person’s body through entry points such as their eyes, nose, mouth, and open or broken areas of skin, such as cuts, incisions and wounds.

Diagnosing CPE

Your child’s health-care provider may test for CPE by taking samples of your child’s stool (poop) or by performing a rectal swab (a swab in the anus). The samples are then sent to the laboratory for CPE testing. Your child’s health-care provider may test for CPE if your child lived outside of Canada within the past year.

CPE infections are treated with antibiotics

If your child has CPE but it is not causing any harm (e.g., your child is “colonized”), no treatment will be needed. If your child develops an infection caused by CPE, they will be treated with antibiotics.

What special precautions are required for CPE while your child is in the hospital?

Your child’s health-care team will continue to provide the same level of patient care. They will take additional precautions to prevent the possible spread of the bacteria:

• Your child will be moved to a single patient room.
• A Contact Precautions sign will be placed on your child’s door to remind staff who enter the room about the special precautions.
• You will notice staff wearing a gown and gloves when entering your child’s room.
• Everyone who enters and leaves your child’s room must clean their hands.
• Your child’s hospital record will indicate they are CPE positive so that if your child visits the hospital again, health-care workers are aware your child has CPE.
• You may notice more frequent cleaning of your child’s room.
• Your child will not be able to visit the playroom or other family spaces.

Possible complications of CPE

CPE can cause infections in any part of the body (e.g., lungs, bloodstream, abdomen, urinary tract and central venous catheters). These infections are particularly difficult to treat since CPE are resistant to almost all available antibiotics.

What will happen at home?

• It is important to wash hands often at home for at least 15 seconds, especially after using the bathroom and before preparing food.
• No special cleaning of items in your home is required.
• Your child’s clothing may be laundered in the usual way, along with the rest of the household laundry.
• If you go to another health-care facility, visit another health-care provider or have home care services, you should tell them your child has CPE. They may use additional precautions when providing care, which will help prevent spread to others and help your child’s health-care provider choose the correct antibiotic treatment if needed.

CPE and serious illness

It can be difficult to choose the right antibiotic to treat a CPE infection. It is important to know if someone has CPE so they can be treated with the right antibiotics. If you have concerns about whether your child or someone else in your family has CPE, ask a health-care provider.

Resources

Public Health Ontario: https://www.publichealthontario.ca/en/Diseases-and-Conditions/Health-Care-Associated-Infections/CPE