Laboratory: Clinical Microbiology
Test Name:
CARBAPENAMASE-PRODUCING ENTEROBACTERIACEAE (CPE), CULTURE, SURVEILLANCE, RECTAL SWAB
Test Code: CPO
Clinical Information:
Test Indications:
Carbapenemase-producing Gram-negative bacilli produce a β-lactamase enzyme that can break down carbapenem antibiotics that may be used to treat serious infections. Carbapenemase genes are often carried on plasmids and are transmissible. Carbapenemase-producing Enterobacteriaceae (CPE) commonly include E. coli, Klebsiella species and Enterobacter species and frequently carry resistance genes to other antibiotics. CPE have been reported world-wide but remain rare in Manitoba.
CPE surveillance is NOT performed routinely. It is performed upon approval by Infection Control and Prevention or cleared by a Microbiologist.  Patients considered high-risk of harboring a CPE include those exposed to a CPE patient or with recent hospitalization in an endemic region.
Screening for CPE is performed using a culture-based test to look for their presence in stool, followed by additional testing to confirm carbapenemase production.

Recommendations:
The use of this test is initiated by Infection Prevention and Control or following a consult with a Microbiologist.
CPE surveillance must be specified under “Other Tests/Surveillance Requests”. Test justification must be indicated, e.g. “CPE Suspect”, "CPE Contact" or “Approved by IP&C”
Do not screen patients known to be CPE positive.
A negative CPE culture result does not rule out the presence of CPE.

Rejection Criteria:
Accurate patient identification must be made prior to sample collection. Sample containers and requisitions must be labeled/completed in accordance with the Shared Health Specimen Acceptance Policy.
Rectal swabs submitted for CPE screening should be visibly soiled with fecal material.
Collection Devices:
Preferred Device:
1 - eSwab  - Rectal swab:  Gently insert the swab ~1 in. beyond the anal sphincter. Gently rotate, remove it, and place it in transport medium. The swab must be visibly soiled.
Peri-rectal swab:  swab the peri-rectal area and place it in transport medium. The swab must be visibly soiled.
Ostomy:  swab the stoma site and place it in transport medium. The swab must be visibly soiled. A rectal swab should also be submitted.
Alternate Device:
1 - Sterile Specimen Container (100 mL)  - Unpreserved stool only
Specimen Required: Rectal swab, stool, peri-rectal swab (for pediatric patients or patients in D6 at the Health Sciences Centre), GI ostomy swab
Swabs should be visibly soiled with fecal material. Unsoiled swabs are sub-optimal.
Referral:
Requisition:
Reference Values:
Negative: No CPE isolated.
For positive samples, a descriptive report will be provided.
Availability:
Daily
See Also:
More Information:
Specimen Handling:
Specimen must be delivered to the laboratory as soon as possible and ideally within 24 hours of collection.
Local: ≤2 hrs, store at room temperature.
Courier/local storage:  ≤48 hrs (≤24 hrs optimal), store at 4°C.
Ensure samples that are being sent to a referral laboratory are packaged in accordance with Transport of Dangerous Goods recommendations for diagnostic samples.