Saturday 15 December 2018

Explainer: All you need to know about potentially fatal superbug CPE

Minister for Health Simon Harris Picture: Steve Humphreys

Sean Nolan

Minister for Health Simon Harris announced yesterday that he has called a meeting of the National Public Health Emergency Team to co-ordinate a response to an increased incidence of Carbapenemase Producing Enterobacteriaceae (CPE) in Ireland.

Here is all you need to know about the potentially fatal superbug.

What is CPE?

According to the Department of Health, Carbapenemase Producing Enterobacteriaceae CPE (also referred to as carbapenem resistant Enterobacteriaceae (CRE)) are an emerging threat to human health, particularly in hospital settings.

CPE have developed the ability to become resistant to last-resort powerful antimicrobials known as carbapenems, which makes them more challenging to treat if they go on to cause infection.

CPE are bacteria that are carried in the gut and are resistant to most, and sometimes all, available antibiotics.

Earlier this year the HSE said that of all the superbugs they had seen, CPE is the hardest to kill.

How is it spread?

Again, according to the Department of Health, CPE are shed in the faeces and transmitted by direct and indirect contact. A period of four weeks or more may elapse between that contact that results in acquisition of the organism and the time at which CPE becomes detectable in the faeces.

How dangerous is it?

If CPE stays in the gut, it is mostly harmless. However, if it spreads to the urine or blood it can be fatal.

More than half of all patients who develop blood stream infections with CPE die as a result of their infection.

How many incidents have been recorded in Ireland?

The HSE say the first instance in Ireland was detected in 2009 and the numbers have been on the increase ever since.

Speaking yesterday, Minister Harris said: “We have seen a rapid and worrying increase in the incidence of CPE in Ireland, with a significant increase in numbers of cases of CPE in recent years. Known outbreaks have occurred in eight healthcare facilities in Ireland resulting in high costs and bed closures."

The HSE said earlier this year they believed the number of people carrying CPE is "fairly small".

This afternoon the HSE told that "there has been 306 people confirmed as having CPE in 2017 (to end of September), this compares to 283 in 2016. 

"These numbers include new patients testing positive for CPE in Ireland. 

"Most of these patients are carrying CPE but are not sick as a result of CPE (gut colonisation) but a number of patients have had serious infection."

As for fatalaties related to CPE. the HSE said: "Clinical antibiotic resistance is making people suffer more and die younger than they need to. It is extremely difficult to put exact numbers on mortality rates because many of the people who die early as a result of antibiotic resistance are people who already had an underlying serious illness."

What happens if it is discovered I am carrying CPE?

The HSE advice earlier this year said that if CPE stays in the gut it does no harm and those carrying it won't have any symptoms such as diarrhoea, vomiting or upset stomach.

However, if they do discover you are carrying it in a hospital, they will try to minimise your contact with other patients and staff will wear extra clothing such as aprons, gloves and surgical gowns when interacting with you.

So what are the Department of Health doing?

Speaking yesterday, Minister Harris said: "I am now convening the National Public Health Emergency Team and activating the National Public Health Emergency Plan. There is experience from other countries that a vigorous response in good time can contain CPE and so I am committed to tackling this with the urgency it requires.

"We are now taking a number of important steps. A National Public Health Emergency Team (NPHET) will be convened next week. This group will provide advice, guidance, support and direction on the surveillance and management of CPE at national level; the development and implementation of a strategy to contain CPE and provide oversight. NPHET will conduct its work having regard to the broader healthcare associated infections (HCAI) and Antimicrobial Resistance (AMR) issues in line with Ireland’s National Action on AMR 2017-2020 (iNAP),which I have launched today.”

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