New notifiable condition: carbapenemase-producing Enterobacterales

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)
 

Carbapenemase-producing Enterobacterales (CPE)

11 September 2019 -  Carbapenemase-producing Enterobacterales (CPE)


SA Health has been informed of a cluster of 10 cases of CPE in patients recently admitted to Flinders
Medical Centre (FMC). The first case occurred in May 2019 followed by detection of sporadic cases
suggestive of transmission between hospitalised patients at FMC. CPE is not a notifiable disease, however,
a total of 21 cases of CPE have been detected in 2019, compared with 11 cases in 2018 and 5 cases in
2017.

Carbapenemase-producing Enterobacterales (formerlyknown as Enterobacteriaceae) are bacteria that are
resistant to Carbapenem antibiotics (e.g. meropenem), a class of ‘last resort’ antibiotics for treating serious
infections. CPE remains uncommon in Australia compared with Europe, North America, the Middle East
and Asia. The first documented outbreak of CPE in Australia occurred in December 2012 and the number
of CPE cases has continued to increase. To date South Australia has had minimal numbers of CPE cases,
with most being associated with patients who have acquired CPE overseas or interstate.
 

COMMUNICABLE DISEASE 
CONTROL BRANCH
- Attention all doctors - 
Date: 11/09/2019     Contact telephone number: 1300 232 272  (24 hours/7 days)

 

Carbapenemase-producing Enterobacterales (CPE)

 

SA Health has been informed of a cluster of 10 cases of CPE in patients recently admitted to Flinders
Medical Centre (FMC). The first case occurred in May 2019 followed by detection of sporadic cases
suggestive of transmission between hospitalised patients at FMC. CPE is not a notifiable disease, however,
a total of 21 cases of CPE have been detected in 2019, compared with 11 cases in 2018 and 5 cases in
2017.

Carbapenemase-producing Enterobacterales (formerlyknown as Enterobacteriaceae) are bacteria that are
resistant to Carbapenem antibiotics (e.g. meropenem), a class of ‘last resort’ antibiotics for treating serious
infections. CPE remains uncommon in Australia compared with Europe, North America, the Middle East
and Asia. The first documented outbreak of CPE in Australia occurred in December 2012 and the number
of CPE cases has continued to increase. To date South Australia has had minimal numbers of CPE cases,
with most being associated with patients who have acquired CPE overseas or interstate.

CPE is transmitted via direct or indirect contact with a person with CPE, or from contaminated
environmental surfaces or fomites. Patients can be colonised with CPE or develop serious infections
including urinary tract, abdominal, bloodstream and respiratory infections, which may be fatal.

Healthcare practitioners can assist in reducing the risk of transmission of CPE through implementing
existing infection prevention and control strategies including antimicrobial stewardship, standard
precautions (including compliance with hand hygiene) and transmission based precautions as indicated.

Doctors with patients who have been identified as contacts of a patient with CPE are asked to:
Perform CPE screening as per the advice in the FMC CPE contact letter or infection control alert. Take
a faecal specimen or rectal swab, plus a groin swab. Request CRE screen on the pathology form.
Manage the patient with standard and transmission based precautions (contact) whilst in a healthcare
or residential care facility, pending results i.e.hand hygiene, environmental hygiene, isolation in a
single room, use of personal protective equipment (gloves and gowns) and dedicated equipment.
Doctors with adult patients directly transferred from FMC (after a stay of at least 24 hours) to
another hospital, healthcare or a residential carefacility are asked to:
Arrange a CPE screen via faecal specimen or rectalswab, plus a groin swab, on arrival at the receiving
facility. Repeat at 7 days if the person remains an inpatient/resident.
Manage the patient with standard precautions (unless the patient has additional transmission risk
factors e.g. diarrhoea), whilst awaiting results.
Doctors with patients identified of having CPE colonisation or infection are asked to:
Consider discussion with an infectious diseases physician or microbiologist, particularly to assist with
managing infection.
Manage patients in healthcare and residential caresettings with transmission based precautions.
Advise patients in general household settings of good hygiene measures including hand hygiene, using
own towels and personal grooming items, and covering wounds to minimise the spread of CPE

Further clinical information is available at SA Health multidrug-resistant organisms (MRO) web page:
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/healthcare+associated+infections/multidrug-resistant+organisms+mro
For all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days)
Dr Louise Flood – Director, Communicable Disease Control Branch
Public – I3-A2

Download the official health alert here (PDF)
 

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