Guidance on notification of CPE

Case definition: The identification of carbapenemase-producing Enterobacteriaceae* (CPE) from any specimen, whether a diagnostic (invasive, non-invasive infection or colonisation, also known as carriage) or screening specimen (colonisation, also known as carriage).

Please notify the first isolate of each culture-confirmed carbapenemase type per patient
For suspected or probable CPE isolated from culture, wait for confirmation of carbapenemase prior to notification. If local confirmation unavailable, refer to National CPE Reference Laboratory Service (NCPERLS) for confirmation. Please also refer all locally-confirmed new carbapenemase producing isolates to National CPE Reference Laboratory Service for WGS, mcr1 testing, additional susceptibility testing (e.g., ceftazidime-avibactam, colistin etc.). Additionally, all CPE isolates causing invasive infection (blood, CSF or other normally sterile site) should also be referred to NCPERLS, even if a previous isolate of the same carbapenemase type from that patient was already referred to NCPERLS

Do not notify CPE if only detected using a molecular method performed directly on a specimen and where the presence of CPE is not confirmed on culture. Where a molecular method for carbapenemase detection is used directly on specimens and a carbapenemase gene is detected, it is strongly recommended that culture is always attempted to confirm the presence of CPE. If necessary, submission of a subsequent specimen to the laboratory should be requested, where feasible

Do not notify isolates that are resistant to carbapenems due to a mechanism that is not carbapenemase production (e.g. ESBL production and porin loss)

Do not notify carbapenemase production in non-Enterobacteriaceae (e.g., Acinetobacter baumannii or Pseudomonas spp.) via this system – These may be notifiable under the category ‘novel or rare antimicrobial resistant organism (NRAO). Guidance should be sought from the relevant reference laboratory and HPSC:

• If a patient has a subsequent isolate with a different carbapenemase type detected (e.g., previously notified with OXA-48, now has KPC detected), the latest newly detected CPE (i.e., KPC) should be notified as a new case
• If a patient has a subsequent isolate with a the same carbapenemase type detected but in a different Enterobacteriaceae (e.g., first notified as OXA-48 E. coli in February, now has OXA-48 Enterobacter cloacae detected in December), the latest isolate is not notifiable, as the carbapenemase type is the same type
• If a patient has a CPE first isolated from a screening specimen and then subsequently from a blood culture or other normally sterile body site (e.g., OXA-48 from rectal swab in February and OXA-48 from blood culture in October), the first detection of the CPE (rectal swab) is notifiable and any subsequent invasive CPE infection (defined as isolation of culture-confirmed CPE from blood, CSF or any normally sterile body site) is also notifiable

*Enterobacteriaceae are also known as Enterobacterales

Created: 5 February 2019