Diagnostics
Confronting CPE: the need for rapid diagnostics
Dr. Devasena Gnanashanmugam discusses the rising rate of Carbapenemase- producing Enterobacterales (CPE) infections and the urgent need for strategic screening and rapid diagnostics.
Carbapenemase-producing Enterobacterales (CPE) infection rates in England have more than doubled since 2020 raising alarm but also requiring careful consideration.1
When
examining these rates, there are important questions to ask: are we seeing more cases because healthcare providers are now paying closer attention and conducting more testing? Or does this reflect a genuine increase in CPE prevalence? The answer appears to be both. Enhanced surveillance and testing awareness represents progress, yet the underlying increase in CPE cases presents a significant challenge requiring strategic response.
Understanding CPE: more than just colonisation CPE refers to a group of gram-negative bacteria that have developed resistance to carbapenems, a class of broad-spectrum antibiotics. Gram negative organisms, whether drug resistant or not, exist as part of normal flora and many are vital to us, contributing to the healthy functioning of our gut and other organ systems. The critical distinction lies in what occurs when individuals colonised with carbapenem resistant organisms become immunocompromised or face significant health challenges. In these circumstances, the probability of developing active CPE infection increases substantially. Screening through rectal swabs identifies patients carrying these organisms before infection develops. Identifying these organisms enables implementation of appropriate infection control measures and informs treatment decisions should subsequent infection occur. In England, the “Big 5” carbapenemase families - KPC, OXA-48-like, NDM, VIM, and IMP - account for over 97% of CPE cases, with K. pneumoniae, E. coli, and Enterobacter species serving as the most common hosts.2
Understanding which
carbapenemase is present directly impacts treatment decisions, as different resistance mechanisms respond differently to available therapies.
The threat to antibiotics of last resort Carbapenems represent antibiotics of last resort due to their remarkably broad spectrum of activity. This characteristic, however, creates a paradox. The fundamental principle of infectious disease treatment involves matching the narrowest appropriate antibiotic spectrum to the specific causative organism. Routine deployment of broad-spectrum antibiotics like carbapenems drives bacterial adaptation towards resistance. CPE emergence signifies organisms already
resistant to these broadly-acting antibiotics. Loss of carbapenem effectiveness forces reliance on an increasingly limited pipeline of alternative drugs. The challenge remains constant: regardless of new antibiotic development, each drug possesses its own spectrum of activity, effective against certain organisms while ineffective against others. No single drug will combat all bacterial infections. Preserving the existing antimicrobial arsenal becomes essential.
Vulnerable populations at greatest risk
Certain populations face particularly severe consequences from CPE infections. Infants demonstrate high vulnerability, as do elderly patients. Immunocompromised individuals, including cancer treatment recipients, organ transplant patients, and dialysis patients, face elevated risk of both infection and mortality. These populations experience not merely higher infection rates but significantly worse outcomes. Studies demonstrate that CPE colonisation correlates with longer hospital stays.3
a life-threatening situation for the most vulnerable patients.
The economic and operational burden CPE consequences extend beyond individual patient outcomes. A 2017 West London outbreak affecting 40 patients across five hospitals incurred estimated costs of €1.1 million over 10 months (approx. £960,080),
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Beyond clinical concerns, this represents
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