Carbapenemase-producing organisms (CPO)

What are Carbapenemase-producing organisms

Carbapenemase-producing organisms (CPO) are a group of bacteria (germs) that have become resistant to many antibiotics, including a type of antibiotic called carbapenems. The CPO produce an enzyme called carbapenemase that makes the antibiotic no longer effective in fighting infections. Carbapenems are powerful antibiotics used to treat serious infections.

This group of bacteria include Enterobacterales (found in human and animal gut), Pseudomonas aeruginosa (found in soil and water) and Acinetobacter baumanii (found in soil, water and on human skin). 

How do you get a CPO?

Some people carry CPO in their gut, respiratory tract or on their skin without developing an infection or becoming sick. This is called colonisation and does not require any treatment. If CPO moves to another part of the body, you may develop an infection and require treatment. CPO can cause urinary tract, bloodstream and wound infections, or pneumonia. Infections due to CPO can be difficult to treat.

CPO is usually spread from person to person through contact with hands or equipment with CPO on them or from touching contaminated environmental surfaces. CPO is not spread through the air by coughing or sneezing. You can spread or pick up CPO in the community or in hospital.

People are more likely to become colonised with a CPO or get an infection if they have:

• been hospitalised overseas or travelled to a country where CPO are common
• recently had a long hospital stay, been in intensive care or had complex surgery
• had CPO before or been in contact with others who have a CPO
• been treated with antibiotics for a long time, or used a lot of different antibiotics
• had chemotherapy in the last 12 months
• an indwelling medical device, such as a urinary catheter in place.

What are healthcare facilities doing to prevent spread

Infection prevention and control (IPC) measures are actions taken at healthcare facilities to prevent or stop diseases from spreading. Healthcare facilities use the same IPC measures for patients colonised or infected to help prevent spread of CPO to others.

If you are colonised or infected with CPO, you will still receive the same level of care in hospital. Healthcare providers can help stop it from spreading with these actions:

• performing frequent handwashing or use an alcohol-based hand rub when providing care to you
• a sign will be placed on your door to remind others of the precautions they need to follow, for example, to wear a gown and gloves when providing care
• being cared for in a single room with your own bathroom 
• frequent cleaning and disinfection of your room, bathroom and medical equipment
• ensuring visitors clean hands with alcohol-based hand sanitiser or soap and water. In addition, visitors should avoid using your hospital bathroom or visit other patients in hospital immediately after visiting you.

Patients infected or colonised with CPO often continue to have it for a very long time. Precautions are taken until they are discharged.

For patients living in settings like nursing homes, long-term measures are taken based on the facility's policy.

Screening

Screening patients for CPO is an important way to prevent or stop outbreaks in healthcare facilities and keep patients safe. Patients who are colonised with CPO may not know it because they do not have any symptoms.

If someone has a history of being in a hospital or residential care facility, overseas or outside of WA in the last 12 months, a specimen to look for CPO (either a stool sample or a rectal swab) will be collected when they are admitted to hospital. Screening results for CPO are used to help guide infection prevention and control strategies in healthcare facilities, which helps prevent it from spreading.

Notification

Carbapenemase-producing organisms are a notifiable condition in Western Australia. This means healthcare providers and laboratories must inform the Department of Health of your CPO positive result. Notification is confidential.

If you test positive for a CPO, an alert will be placed in your medical record to let your healthcare provider know you have CPO. This alert can be seen in all public hospitals in WA. Should you go to a private hospital, or another healthcare provider e.g. your local doctor, you need to tell them you have CPO. There is no need to tell other community services or businesses that are not health care services e.g. swimming pools, gyms or schools that you have CPO.

Can CPO be treated?

People colonised with CPO do not need to have any treatment or antibiotics.

Infections caused by CPO can be very difficult to treat. People with an infection caused by CPO may require antibiotics and this is best managed with advice from a specialist doctor who can help identify the best antibiotic treatment.

There is no vaccination available to prevent you from acquiring CPO or treatment to eliminate CPO from your body.

What will happen when I go home?

There is no need to take special precautions at home, but it is important that you and your family continue to practice good hygiene including:

• always washing your hands with soap and water:
  • after going to the toilet
  • before preparing meals and eating food
  • before and after touching any wounds or lesions or medical devices you may have.
• use your own towels and face cloths and do not share them
• do not share grooming items, such as brushes, nail scissors, or razors
• cover any skin wounds if possible.

No special cleaning is required in your home and your clothing may be laundered as usual, along with the rest of the household laundry. All eating utensils and dishes can be washed in the normal way. You can return to work.

More information

• If you are in hospital, you can ask to speak to the infection prevention control nurse.
• See your doctor.
• Ring healthdirect Australia on 1800 022 222.

Remember

• CPO are a group of bacteria (germs) that have become resistant to many antibiotics.
• Infections caused by CPO can be serious and difficult to treat.
• Hand hygiene is a simple but very effective measure that stops the spread of germs.
• Remember to tell your healthcare provider you have CPO.

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This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.