Hutt Valley DHB has identified five carriers of Carbapenam Producing Enterobacteriaceae (CPE) – a family of bacteria resistant to nearly all antibiotics.

Carbapenems are a group of antibiotics often used to treat complex infections, or when other antibiotics have been ineffective.

Hutt Valley DHB infectious diseases senior medical officer, Dr Matthew Kelly, says the community need not be alarmed, but should be aware.

“The first line of defence against any bacteria is thorough and frequent handwashing, especially after going to the toilet, and before preparing and eating food.”

Two people were identified in hospital, and three in the community. In all but one person it was an incidental finding, and hasn’t resulted in illness. The one person who did have illness has been successfully treated.

“We are taking the presence of CPE in the community extremely seriously.”

“CPE is extremely rare in New Zealand, but also concerning because of its resistance to antibiotics, which is why we are alerting our community.

“We are closely managing the five patients and working with their health care professionals. We are contacting those people who may have been in contact with the two patients who were in hospital to provide them information about CPE.

“The bacteria can be in your gut for months to years and will usually cause no harm. There is no effective way to remove it from the gut and it may stay for longer if you take other antibiotics. The bacteria can cause infection in vulnerable people if it gets into the wrong place such as in the urine or a wound from surgery.

“In the hospital – good infection control practices are an essential and everyday part of health care. The silver lining to this cloud is that we have identified these cases through our standard screening procedures and have been able to manage this situation.”

In New Zealand most previous cases have been linked with travel overseas. This cluster of cases appears to have originated in the community, however Hutt Valley DHB has not, to date, been able to confirm the source of infection.

Concern about the continuing development and spread of antibiotic resistance is worldwide. There have been very few new classes of antibiotics in the past 20 years and unless that situation changes, we will encounter more bacteria that we can’t treat effectively said Dr Kelly.

“Antibiotics save lives but we must use them responsibly and wisely.”

Actions to Date:

• We are checking contacts for the five patients with confirmed colonisations to understand if there are signs of spread - none has been found at present.

• We are getting in touch with contacts who have left hospital and their general practice teams to explain what is happening.

• Other DHBs, the Ministry of Health and the Health Quality and Safety Commission have been informed.

• We are in the process of informing other health care professionals in environments that deal with vulnerable people, such as hospitals, aged residential care facilities, community nursing and general practice.

• We are reminding staff to be extra vigilant in use of hand hygiene and infection control.

Although the level of public risk has been assessed as low. Information about CPE can be found at www.huttvalleydhb.org.nz

Questions and Answers

What do people need to know about CPE?

• Infections with CPE are preventable and extremely rare.

• The presence of CPE in the gut (colonisation) doesn’t mean you’ll get sick.

• Good hand hygiene and other infection control practices such as thorough cleaning of surfaces and equipment are an effective way to reduce the risk of spreading.

• Remember to use antibiotics in a careful way because inappropriate use of antibiotics contributes to the spread of CPE.

Where have these cases occurred?

Our routine laboratory processes have detected the presence of CPE in five patients, two at Hutt Valley DHB and three in the community.

When were they discovered?

We had the first confirmed laboratory result on Saturday 25 August and the most recent case was identified this Friday 12 October. Patients and their health professionals have been informed of the results immediately.

Why are you telling people now?

We are communicating proactively as soon as is reasonably possible, bearing in mind we assessed the risk to the general public as being low.

We wanted to make sure our communications are well planned otherwise we risk sending confusing messages.

Other health agencies were told immediately as we recognise it could affect their patient care.

How were the cases discovered?

CPE is detected on standard microbiology tests requested by health professionals. We also carry out additional screening as part of everyday care in the hospital.

How has Hutt Valley DHB communicated with the families of the people carrying CPE?

Patients are phoned to discuss the result and sent written information. In some cases one of our Infection Prevention and Control nurses will also visit patients to discuss the results further.

How common is it?

There have been an increasing number of CPE cases identified in NZ and so far this year there have been around 50 cases. Most people found to have CPE in New Zealand became infected overseas, particularly if they had been in an overseas hospital.

Is CPE common in New Zealand or have people picked it up elsewhere?

It is uncommon in New Zealand, but may be picked up while travelling overseas.

What can people do to prevent CPE?

Good hand and food hygiene is the best prevention. Where soap and water isn’t available, an alcohol-based hand sanitiser is effective.

How do you get CPE?

CPE is found in the gut bacteria of a carrier and is transferred by touch to surfaces, skin or food when that person hasn’t washed their hands properly after going to the toilet. Someone else can then unknowingly transfer the bacteria to their mouth.

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