25 October 2019 -  New notifiable condition: carbapenemase-producing Enterobacterales 

Following a recent marked increase in the number of cases of people colonised or infected with
carbapenemase-producing Enterobacterales (CPE) in South Australia, SA Health has made CPE
a notifiable condition under the South Australian Public Health Act 2011, effective immediately
and until further notice.  

Enterobacterales is an order of Gram-negative bacteria which includes common gut organisms
such as Enterobacter, Escherichia and Klebsiella. CPE are members of Enterobacterales that are
resistant to most, or even all, types of antibiotics including Carbapenems and are considered to
be a significant global health threat. 

 

COMMUNICABLE DISEASE 
CONTROL BRANCH
- Attention all doctors - 
Date: 25/10/2019     Contact telephone number: 1300 232 272  (24 hours/7 days)

 

New notifiable condition: carbapenemase-producing Enterobacterales 

 

Following a recent marked increase in the number of cases of people colonised or infected with 
carbapenemase-producing Enterobacterales (CPE) in South Australia, SA Health has made CPE 
a notifiable condition under the South Australian Public Health Act 2011, effective immediately 
and until further notice.  

Enterobacterales is an order of Gram-negative bacteria which includes common gut organisms 
such as Enterobacter, Escherichia and Klebsiella. CPE are members of Enterobacterales that are 
resistant to most, or even all, types of antibiotics including Carbapenems and are considered to 
be a significant global health threat. 

Diagnostic laboratories are required to: 

  • Notify all cases of CPE to the Communicable Disease Control Branch (CDCB), including
    suspected cases prior to confirmation from a reference laboratory.
  • Advise the requesting doctor (e.g. via the testing report) that CPE, including suspected
    cases, must be notified to CDCB within 3 days, preferably sooner.
Doctors are required to:
  • Notify all confirmed or suspected cases of CPE to CDCB within 3 days of receiving information from the laboratory.
Doctors are also advised to:
  • Seek advice from an infectious diseases physician or clinical microbiologist regarding appropriate management of patients with CPE (either infected or colonised).
  • Ensure transmission based precautions are in place if the patient is being managed in or to be transferred to a healthcare or residential care setting.

Carbapenems are a class of ‘last resort’ antibiotics including imipenem, meropenem, ertapenem
and doripenem which are usually reserved for treating serious infections or when an infecting
organism is resistant to commonly used antibiotics. The production of carbapenemase enzymes
which inactivate these drugs means that this group of antibiotics and related cephalosporins and
penicillins are no longer effective. Often no oral antimicrobial is available, and most patients will
need to be hospitalised for intravenous therapy even for otherwise uncomplicated infections. 

CPE have the ability to spread rapidly, and resistance genes are easily transferred between
bacterial species. Patients can be colonised with CPE or develop serious infections including
urinary tract, abdominal, bloodstream and respiratory infections, which are associated with high
mortality rates. While many early infections in Australia were associated with imported cases,
frequently linked to medical treatment overseas, CPE are now spreading within Australia. Last
year, CPE were the most commonly identified bacteria with critical antimicrobial resistance in this
country, making up >40% of all reports, with most cases reported from the eastern states. Cases
are now increasing in South Australia (see Public Health Alert). 

Further information is available at SA Health multidrug-resistant organisms (MRO) web page. 
For all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days) 
Dr Louise Flood – Director, Communicable Disease Control Branch 
Public – I2 – A2 

Download the official health alert here (PDF)
 

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