Carbapenemase-producing Enterobacteriaceae
โ ๏ธ Note: Infections due to CPE are associated with significantly higher in-hospital mortality.
Strict infection prevention and control (IPC) is essential.
๐ About
- Common organisms: E. coli and Klebsiella pneumoniae are most frequent causes.
- Other genera: Enterobacter, Serratia, Proteus.
๐งฌ Aetiology
- Carbapenemases = enzymes that hydrolyse carbapenems โ high-level resistance.
- KPC (Klebsiella pneumoniae carbapenemase): Widely distributed globally.
- NDM (New Delhi metallo-ฮฒ-lactamase): Particularly concerning in South Asia; broad ฮฒ-lactam resistance.
- VIM & IMP: Verona integron-encoded and imipenemase metallo-ฮฒ-lactamases.
- OXA-48: Common in Europe & Middle East.
๐ฉบ Clinical
- Infections: UTI, sepsis, pneumonia, intra-abdominal infections.
- Treatment challenges: Most ฮฒ-lactams ineffective. Therapy often requires older/more toxic drugs (colistin, tigecycline, aminoglycosides). Newer options include ceftazidimeโavibactam or meropenemโvaborbactam (specialist use).
๐ฆ Transmission
- Healthcare settings: Spread via contaminated hands, equipment, or surfaces.
- Colonisation vs infection: Patients may carry CPE asymptomatically yet remain infectious. Risk of invasive infection โ if immunocompromised or exposed to invasive devices.
๐ High-Risk Admissions
- Patients transferred/admitted from overseas hospitals (esp. Bangladesh, Balkans, China, Cyprus, Greece, India, Israel, Italy, Malta, Middle East, Pakistan, SE Asia, South/Central America, Turkey, USA, etc.).
- Any hospital abroad within 12 months should trigger a CPE risk assessment.
๐ Risk Assessment Questions
- Is the patient a lab-confirmed case of CPE (infection or colonisation)?
- Has the patient been an inpatient in a hospital abroad (last 12 months)?
- Has the patient been in a UK hospital with known CPE cases or close contact with colonised patients?
๐ฌ Investigations
- Molecular: PCR for carbapenemase genes (KPC, NDM, VIM, OXA-48, etc.).
- Phenotypic: Modified Hodge test, Carba NP test, or disk diffusion assays.
- Culture & sensitivity: to guide antimicrobial choice.
โ๏ธ Management
- ๐๏ธ Isolation: Side room with en-suite facilities. Strict contact precautions.
- ๐งด Infection control: Hand hygiene, dedicated equipment, enhanced cleaning.
- ๐งช Screening: Rectal swabs to detect colonisation in high-risk or contact patients.
- ๐ Alert IPC team: Ensure flagging for future admissions.
- ๐ Treatment (infection only): Under microbiology guidance. Options include colistin, tigecycline, aminoglycosides, or newer ฮฒ-lactam/ฮฒ-lactamase inhibitor combinations (depending on sensitivity).
- Patients who test positive remain isolated for the duration of admission.
๐ References
