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Carbapenemase-producing organisms
'Carbapenem-resistant organisms' (CPO) are a group of drug-resistant bacteria that includes the very high risk 'Carbapenemase-producing enterobacteriaceae' (CPE).
About carbapenemase-producing organisms (CPOs)
CPOs are generally harmless bacteria found in the gut, but they can be responsible for a variety of infections including:
- urinary tract infections
- wound infections
- gastroenteritis
- meningitis
- septicaemia
- pneumonia.
CPOs include 'Enterobacteriaceae' — a large and diverse family of gram-negative bacteria, which are the most common cause of both community-acquired and health care-acquired infections.
'Carbapenem-resistant Enterobacteriaceae' (CRE) are Enterobacteriaceae that are resistant to carbapenem antibiotics.
'Carbapenemase-producing Enterobacteriaceae' (CPE) are defined as any of the CRE that harbour a gene encoding carbapenemase (a β-lactamase).
CPE are often also resistant to many other classes of antimicrobial agents. Infections have a high mortality rate.
How CPOs spread
Most cases of infection or colonisation by CPOs are found during surveillance when people are admitted to healthcare facilities. If they have recently been to an overseas hospital, they may be tested for this bacterium.
CPOs have spread rapidly due to:
- global movements
- medical tourism
- transmission of plasmids carrying the gene from one bacterium to another.
Sporadic cases of colonised or infected people have been reported in a range of countries across most continents. Typically, these patients have recently received healthcare in a country with a high prevalence of CPO.
CPOs in Aotearoa New Zealand
In Aotearoa New Zealand, the number of CPO carriers and infections has increased sharply in recent years. In the past, nearly all CPO have been imported from overseas. But there are now carriers in the community and transmission happening in healthcare facilities.
While the yearly total goes up and down, in recent years more than 200 people each year have been found to be colonised by CPO based on lab test results.
Carbapenemase-producing organisms case data — PHF Scienceexternal link
Minimising the effects of CPOs
Healthcare facilities need to take a proactive approach and make sure they have strong measures in place to minimise the effect of CPOs.
The key actions to reduce the transmission and spread of CPOs are:
- awareness and education
- early identification
- infection prevention and control measures.
Healthcare facilities should have up-to-date policies and procedures in place to identify and manage CPOs, including:
- screening policies to identify patients at high-risk for colonisation or infection with a CPO
- standard and transmission-based (contact) precautions for all suspected or laboratory-confirmed cases of CPO
- hand hygiene policy
- laboratory procedures to detect and report CPOs
- alerting other healthcare facilities that a patient is colonised or infected with a CPO through the national Medical Warning System
Medical Warning Systemexternal link - infection prevention and control measures such as cleaning and disinfection procedures
- antimicrobial stewardship programmes.
Contact your local Infection Prevention and Control teams for further advice and education.
Suspected or confirmed cases of CPOs
In the event of a suspected or confirmed CPO case, healthcare providers should contact their local Infection Prevention and Control, and Clinical Microbiology Services to discuss it.
CPOs are mainly of concern in healthcare environments. In households, people who are colonised with a CPO or other drug-resistant organism should follow normal hygiene practices.
Ministry of Health CPE guidelines
Ministry of Health provides guidelines for healthcare providers for preventing and managing CPE in acute and residential care facilities.