CARBAPENAMASE-PRODUCING ENTEROBACTERIACEAE (CPE), CULTURE, SURVEILLANCE, RECTAL SWAB

Test Code: CPO

Test Indications:
To determine if a patient is colonized with carbapenemase-producing organisms.
Carbapenemase-producing Gram-negative bacilli produce β-lactamase enzymes that can break down a variety of β-lactam antibiotics, including carbapenems that may be used to treat serious infections. Carbapenemase genes are often carried on plasmids and are transmissible. Carbapenemase-producing Enterobacterales (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 uncommon in Manitoba.
CPE surveillance is NOT performed routinely. It is initiated by Infection Control and Prevention.  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:
For CPE screening criteria please refer to the Winnipeg Regional Health Authority - Acute Care Infection Prevention & Control Manual and/or Manitoba Health, Seniors and Active Living - Guidelines for the Prevention and Control of Antimicrobial-Resistant Organisms.
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.

_SH Microbiology - Provincial Requisition (R250-10-06)

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

Daily

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.