Laboratory: Clinical Microbiology
Test Name:
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.

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.
Reference Values:
Negative: No CPE isolated.
For positive samples, a descriptive report will be provided.
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.