An emerging multidrug-resistant bacteria
========================================

* Jennie Johnstone
* Samir N. Patel

## Carbapenemase-producing *Enterobacteriaceae* (CPE) are emerging multidrug-resistant bacteria

Carbapenemase-producing *Enterobacteriaceae* (CPE) are gram-negative bacteria (e.g., *Escherichia coli, Klebsiella* sp.) that are resistant to most antibiotics, including meropenem, the most broad spectrum antibiotic.1 Incidence of CPE in Canada is increasing: from five cases in 2008 to 779 in 2016 (Dr. Michael Mulvey, National Microbiology Laboratory, Canadian Science Centre for Human and Animal Health, Winnipeg, Man.; personal communication, 2017), and outbreaks in hospitals have been reported.2 In 2017, the World Health Organization named CPE priority 1 pathogens.3

## CPE is most commonly acquired in hospitals and long-term care facilities

Carbapenemase resistance is usually encoded by plasmids that can move between bacteria.1 Carbapenemase-producing *Enterobacteriaceae* reside in the gastrointestinal tract and are endemic in hospitals and long-term care facilities in many countries, including the United States.1 Patient-to-patient transmission occurs by contaminated hands of health care providers or contaminated shared patient equipment.2

## CPE infection has similar clinical manifestations to those of other gram-negative bacteria

Infection caused by CPE will present with symptoms and signs typical of other gram-negative infections (e.g., urinary tract infection, sepsis).1 Colonization of CPE has no symptoms. In Canada, CPE are reliably identified from routine bacterial cultures or screening specimens (e.g., rectal swabs).

## There are limited treatment options for CPE

Colonization does not require treatment.2 Antibiotic treatment options for CPE infection are limited at present and for the foreseeable future; last-line antibiotics (e.g., colistin) may be required.2 Mortality from bacteremia caused by CPE ranges from 25% to 50%;4 expert consultation should be sought for all CPE infections.

## Preventing the spread of CPE requires multiple measures

Measures to prevent spread include requiring screening at-risk patients upon admission to hospital, providing care with gowns and gloves in a private room, meticulous hand hygiene, routine cleaning and disinfection of shared patient equipment, effective hospital cleaning and optimal antibiotic prescribing by physicians. 2,5 Alberta and British Columbia have made CPE a reportable disease, which may facilitate surveillance and timely interventions.

## Footnotes

*   * **PIDAC-IPC:** Chingiz Amirov, Anne Bialachowski, Sandra Callery, William Ciccotelli, Maureen Cividino, Judy Dennis, Gary Garber, Susy Hota, Kevin Katz, Allison McGeer, Matthew Muller, Vydia Nankoosingh, Catherine Richard, Herveen Sachdeva, Mary Vearncombe

*   *CMAJ* Podcasts: author interview at [https://soundcloud.com/cmajpodcasts/170110-five](https://soundcloud.com/cmajpodcasts/170110-five)

*   **Competing interests:** None declared.

*   This article has been peer reviewed.

## References

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4.  Falagas ME, Tansarli GS, Karageorgopoulos DE, et al. Deaths attributable to carbapenem-resistant *Enterobacteriaceae* infections. Emerg Infect Dis 2014;20:1170–5.
    
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