A patient's guide to carbapenemase-producing enterobacterales

Carbapenemase-producing Enterobacterales (CPE) is the name given to a group of bacteria (germs) that have become very resistant to antibiotics including those called carbapenems. Many of these bacteria usually live harmlessly in the gut of all humans and animals and help us digest our food. However, if they get into the wrong place such as the bladder or bloodstream they can cause infection.

Carbapenem antibiotics are a powerful group of antibiotics that can only be given in hospital directly into the bloodstream with a needle. Until now, they were antibiotics that could always be relied upon when other antibiotics failed. Carbapenem resistance matters because there are limited or no antibiotic left to treat CPE infection.

Because Carbapenemase-producing organisms normally live in the gut without causing problems (this is called ‘colonisation’) they do not always need to be treated. However, if they cause an infection then treatment is required. Infections caused by this germ can be very difficult to treat with antibiotics. This is why it is so important to prevent its spread.

Sometimes the bacteria can be found living harmlessly in the gut so it is difficult to say where or when you picked it up. However, there is an increased chance of picking up the bacteria if you have been an inpatient in overseas hospital or in a UK hospital that has had patients carrying the bacteria, or you have been in contact with a carrier elsewhere.

Generally, a patient with CPE will be accommodated in a single room with its own toilet facilities. Healthcare workers will (and should) wash their hands or use alcohol hand gel regularly in between patient care and clinical procedures. They will use gloves and aprons when caring for you to help prevent spread of any germs. The most important measure is for you as a patient to wash your hands whilst in hospital and use alcohol hand gel regularly. It is especially important to wash your hands well with soap and water after going to the toilet. You should avoid touching medical devices (if you have any) such as your urinary catheter tube and your intravenous drip, particularly at the point where it is inserted into the skin. Visitors will be asked to wash their hands on entering and leaving the room. Avoid touching your wounds, especially if CPE has been found in it

The main risk factors for acquiring carbapenemase-producing Enterobacterales (CPE) is having been an inpatient in any hospital either in the UK or abroad. If you have these risk factors we will ask to screen you. You will be informed if the result is positive

The screening method requires a swab to be inserted just into your rectum (bottom) or a stool sample may be requested. Additional swabs of other sites (wound, cannula, etc.) may be requested by the team. The specimens will be sent for testing in the laboratory

If you are found out to be a carrier of this germ, you do not need to be treated but infection control measures (isolation, good personal hygiene, environmental cleaning, etc.) will be in place throughout your hospital admission. If the bacteria cause an infection, then appropriate antibiotics will be prescribed.

If you test positive to carbapenemase-producing Enterobacterales (CPE), while you are certified fit for rehabilitation, a risk assessment will need to be carried out in collaboration with all the specialist health care professionals involved with your care. This is to ensure appropriate planning of your therapy sessions and adherence to the Trust’s infection control policies. This will minimize any interruption to your rehabilitation and prevent possible cross contamination/spread of infection at this Trust.

Whilst you may still be a carrier when you go home, often the bacteria load on your body will recede with time. No special measures or treatment are required. You should carry on as usual, maintaining good personal and hand hygiene and general cleanliness. Your GP will be informed when you are diagnosed with CPE. This is useful information for future admissions to other hospitals.

If you would like any further information please speak to a member of staff, who may contact the Infection Prevention and Control Team for you.