Carbapenemase Producing Enterobacterales Cpe

Overview

Enterobacterales is a large family of bacteria that usually live harmlessly in the human gut, such as E. coli and Klebsiella. Some of these bacteria have learned to make an enzyme called carbapenemase, which breaks down strong antibiotics called carbapenems. This makes the bacteria very hard to treat. When someone has an infection caused by these resistant bacteria, it is called a carbapenemase-producing Enterobacterales (CPE) infection.

CPE is still uncommon, but it is becoming more common in hospitals and long-term care facilities. Most healthy people are not at risk.

CPE mostly affects people who are already ill, have spent time in hospital, live in a nursing home, have medical devices like catheters or drips, or have taken many courses of antibiotics.

Symptoms

Common symptoms

• Many people with CPE have no symptoms at all.
• If CPE causes a urinary infection: pain or burning when urinating, needing to urinate often, or smelly urine.
• If CPE causes a wound infection: redness, swelling, warmth, or pus around a wound.
• If CPE causes a lung infection: cough, phlegm, shortness of breath, or chest pain.
• General signs of infection: fever, chills, feeling tired or generally unwell.

Symptoms in children

• High temperature or fever
• Poor feeding or not drinking enough
• Being unusually fussy or drowsy
• Vomiting
• Breathing faster than normal

Symptoms in older adults

• Confusion or sudden changes in behaviour
• Being unusually sleepy or hard to wake
• Falls or loss of balance
• Loss of appetite
• Low body temperature rather than fever

Causes

Main causes

• CPE bacteria have a gene that produces an enzyme called carbapenemase, which breaks down carbapenem antibiotics.
• These bacteria are spread through direct contact with an infected or colonised person, or through contaminated surfaces and medical equipment.
• Healthcare workers' hands can spread CPE from one patient to another if hand hygiene is not done properly.

Risk factors

• Being in hospital, especially in an intensive care unit
• Living in a long-term care facility
• Having a urinary catheter or IV drip
• Being on a ventilator
• Taking many or long courses of antibiotics
• Having a weakened immune system due to illness or treatment

When to see a doctor

See a doctor urgently if:

• If you have symptoms of infection listed above, especially fever, pain with urination, or a worsening wound.
• If you already know you carry CPE and feel suddenly unwell.

Book a routine appointment if:

• If you have been told you carry CPE and have questions about what it means.
• Before planning a hospital stay, procedure, or pregnancy care, tell your healthcare team about your CPE status.

Diagnosis

Your doctor collects a sample — usually urine, blood, sputum, pus from a wound, or a swab from your rectum — and sends it to a laboratory. The lab checks whether CPE bacteria are present and which antibiotics they are resistant to.

Tests that may be done

• Urine test to check for a urinary tract infection
• Blood test if a bloodstream infection is suspected
• Wound swab if there is a sore or infected wound
• Rectal swab or stool sample to check if you are carrying CPE without symptoms

What to expect at your appointment

The test results usually take a few days. While waiting, healthcare staff may take special precautions, such as wearing gloves and gowns, to prevent spread to others. This is normal and not something to worry about.

Treatment

If you only carry CPE (colonisation), you will not receive any treatment because antibiotics can kill helpful bacteria and may make resistance worse. If you have an active infection, treatment will be tailored to the exact bacteria and its resistance pattern. This often requires hospital care with antibiotics given through a drip.

Self-care at home

• Wash your hands often and well with soap and water or use an alcohol hand rub.
• Wash and dry cuts and wounds carefully, and cover them with a clean dressing.
• Follow any advice from your healthcare team about hygiene and isolation.
• If you are prescribed antibiotics, take them exactly as directed and finish the full course.
• Tell every healthcare provider you see — including dentists and nurses — about your CPE status.

Medical treatments

Infections caused by CPE are treated with specific antibiotics that the laboratory has shown are likely to work. Sometimes a combination of antibiotics is needed, usually given in hospital through an intravenous drip. Your doctors will closely monitor your progress and adjust the treatment as needed.

When is surgery considered?

If you develop a pocket of pus (abscess) as a complication, a small surgical drainage procedure may be needed as part of treatment. Surgery itself is not a cure for CPE infection, but it helps remove the source of infection.

Living with this condition

If you carry CPE, you can live a completely normal life. Keep up your usual routines, work, school, and family life. The main things to remember are good hand hygiene, telling healthcare staff about your status, and staying aware of infection symptoms so you can seek help early if you feel unwell.

Lifestyle tips

• Eat a balanced diet rich in fruits, vegetables, and whole grains.
• Stay physically active — gentle activities like walking or stretching are enough.
• Get enough sleep and manage stress.
• Stay up to date with other recommended vaccines, such as the flu vaccine, to reduce your risk of other infections.
• Avoid using antibiotics unnecessarily, for example for viral colds.

Diet and exercise

You do not need a special diet when you carry CPE. If you have had an infection, eating nutritious meals and doing gentle exercise, like a daily walk, can help your body regain strength. Drink plenty of fluids unless your doctor says otherwise.

Mental health and emotional wellbeing

It is completely normal to feel anxious, embarrassed, or worried when you find out you have a resistant bacteria. These feelings usually ease with accurate information and time. Talk to your GP or your care team — they are there to support you and answer your questions.

Prevention

Yes, to a large degree. Careful hand washing and drying, cleaning of hospital surfaces, using gloves and gowns when needed, and using antibiotics only when truly necessary all reduce the spread of CPE. If you are in hospital, remind staff to clean their hands and ask everyone to wash before touching you.

Vaccines

There is no vaccine that specifically prevents CPE. However, staying up to date with other recommended vaccines, such as the flu or COVID-19 vaccines, helps you avoid getting sick in ways that could make you more vulnerable to resistant bacteria.

Screening programmes

Some hospitals screen patients who are at higher risk, such as those being admitted from a nursing home or with a history of CPE. A rectal swab or stool sample is tested to look for the bacteria, even without symptoms. This helps hospitals take precautions early to stop spread.

Complications

If left untreated

• The infection can spread from the original site (like the bladder or wound) into the bloodstream.
• Bloodstream infection can cause sepsis — a life-threatening reaction to infection.
• Sepsis can lead to organ failure, such as kidney or lung failure.
• Longer hospital stays and a higher chance of severe illness.

Long-term outlook

While CPE infections are serious and need expert medical care, hospitals now have a lot of experience treating them. Many people recover fully, especially when treatment starts early. If you simply carry the bacteria without having an infection, your outlook is very good and you can continue your everyday life.

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