Carbapenemase Producing Enterobacteriaceae (CPE)

HSE | HCAI/AMR Programme

Martin Cormican

HSE National Lead for

Health Care Associated Infection and Antimicrobial Resistance

hcainational.lead@hse.ie

The Next Ten Minutes of Your Life

Background – What is CPE & why it matters

Process & Categories

Information

Summary

Commentary

Thanks

Background: “The Lamps Are Going Out All Over

Europe” (Sir Edward Grey 1914)

Background: Faecal Oral Spread

CPE – faecal oral spread

If someone got CPE they swallowed traces of someone else’s faeces

That should happen a lot less often in

health care delivery than it does

Background: CPE: What it is

First the E = Enterobacteriaceae

E: = normal gut bugs

E: a group of bacteria that belong normally in the gut (normal colonisation)

But: Can get into urine (cystitis/pyelonephritis), gall bladder (cholecystitis) and blood (blood stream infection/septicaemia)

Background: Now the C in CPE: What it is

Carbapenems (a family of antibiotics) meropenem is best

know example in Ireland

C = Carbapenem”ase” – an enzyme that destroys

carbapenem

Background: So CPE: What is it ?

C = Carbapenemase

P = Producing

E = gut bugs

(The term CRE is widely used means more or less the same

thing most of the time)

Background: CPEs Come In Different Colours

(this is not an endorsement of smarties, Nestlé, or any other food high in refined sugar (although I do like smarties I like giant chocolate buttons even more but they are all

the same colour so they were not suitable to illustrate this point)

OXA

KPC

NDM

The Process

• Sample from patient in hospital X (screening /diagnostic) • Clinical laboratory do a test (different ways to do this) • They think is a CPE (or know it’s a CPE) • They send the bacteria with relevant data to CPE Reference

Laboratory Service • CPE Reference Laboratory Service do tests to confirm it is CPE • Coverage: • Estimate that more than 90% of CPE that are found are submitted

within a week to 10 days

The Categories of Sample

• Blood stream = Life threatening infection

• Rectal/faeces = Colonisation

• Other (wound swab, urine, sputum, etc) submitted within a week to 10 days = Colonisation or Infection

The Numbers - Ireland(*)

Total CPE Blood Stream Infections

based on reference laboratory data

(will need cross check)

The Numbers - Ireland(*)

To End of October

332 people newly detected with

CPE

Plus so far in November 33 more

Every hospital group except

childrens

Total - 365

RCSI Hospital Group

Ireland East

Dublin Midlands

Children’s Hospital Group

Different Colour of the Smarties

South Southwest Hospital Group

University of Limerick Hospital Group

Saolta Hospital Group

Summary

• Almost all hospitals are sending CPE to the Reference Laboratory Service (one major exception)

• Our data is reasonably timely and reasonably accurate representation of what is detected by clinical laboratories

• CPE is very widely disseminated • On average more than 1 new person every day is getting CPE • The numbers detected by some hospitals suggest that it is higly likely

that they do not have effective systems for detection • Until every hospital is doing a reasonable level of screening we do

not know how bad the situation is

Commentary

• The numbers detected by some hospitals suggest that it is highly

likely that they do not have effective systems for detection

• Until every hospital is doing a reasonable level of screening we do not know how bad the situation is

Thanks To The People Who Do The Work

Elaine McGrath (The Reference Lab Scientist)

Wendy Brennan

Maria Molloy

Tom Whyte

Background: “we shall not seem them lit again in

our life-time” (Sir Edward Grey again)