Carbapenemase-producing Enterobacterales (CPE)

11 September 2019 -  Carbapenemase-producing Enterobacterales (CPE)


SA Health has been informed of a cluster of 10 cases of CPE in patients recently admitted to Flinders
Medical Centre (FMC). The first case occurred in May 2019 followed by detection of sporadic cases
suggestive of transmission between hospitalised patients at FMC. CPE is not a notifiable disease, however,
a total of 21 cases of CPE have been detected in 2019, compared with 11 cases in 2018 and 5 cases in
2017.

Carbapenemase-producing Enterobacterales (formerlyknown as Enterobacteriaceae) are bacteria that are
resistant to Carbapenem antibiotics (e.g. meropenem), a class of ‘last resort’ antibiotics for treating serious
infections. CPE remains uncommon in Australia compared with Europe, North America, the Middle East
and Asia. The first documented outbreak of CPE in Australia occurred in December 2012 and the number
of CPE cases has continued to increase. To date South Australia has had minimal numbers of CPE cases,
with most being associated with patients who have acquired CPE overseas or interstate.
 

COMMUNICABLE DISEASE 
CONTROL BRANCH
- Attention all doctors - 
Date: 11/09/2019     Contact telephone number: 1300 232 272  (24 hours/7 days)

 

Carbapenemase-producing Enterobacterales (CPE)

 

SA Health has been informed of a cluster of 10 cases of CPE in patients recently admitted to Flinders
Medical Centre (FMC). The first case occurred in May 2019 followed by detection of sporadic cases
suggestive of transmission between hospitalised patients at FMC. CPE is not a notifiable disease, however,
a total of 21 cases of CPE have been detected in 2019, compared with 11 cases in 2018 and 5 cases in
2017.

Carbapenemase-producing Enterobacterales (formerlyknown as Enterobacteriaceae) are bacteria that are
resistant to Carbapenem antibiotics (e.g. meropenem), a class of ‘last resort’ antibiotics for treating serious
infections. CPE remains uncommon in Australia compared with Europe, North America, the Middle East
and Asia. The first documented outbreak of CPE in Australia occurred in December 2012 and the number
of CPE cases has continued to increase. To date South Australia has had minimal numbers of CPE cases,
with most being associated with patients who have acquired CPE overseas or interstate.

CPE is transmitted via direct or indirect contact with a person with CPE, or from contaminated
environmental surfaces or fomites. Patients can be colonised with CPE or develop serious infections
including urinary tract, abdominal, bloodstream and respiratory infections, which may be fatal.

Healthcare practitioners can assist in reducing the risk of transmission of CPE through implementing
existing infection prevention and control strategies including antimicrobial stewardship, standard
precautions (including compliance with hand hygiene) and transmission based precautions as indicated.

Doctors with patients who have been identified as contacts of a patient with CPE are asked to:
Perform CPE screening as per the advice in the FMC CPE contact letter or infection control alert. Take
a faecal specimen or rectal swab, plus a groin swab. Request CRE screen on the pathology form.
Manage the patient with standard and transmission based precautions (contact) whilst in a healthcare
or residential care facility, pending results i.e.hand hygiene, environmental hygiene, isolation in a
single room, use of personal protective equipment (gloves and gowns) and dedicated equipment.
Doctors with adult patients directly transferred from FMC (after a stay of at least 24 hours) to
another hospital, healthcare or a residential carefacility are asked to:
Arrange a CPE screen via faecal specimen or rectalswab, plus a groin swab, on arrival at the receiving
facility. Repeat at 7 days if the person remains an inpatient/resident.
Manage the patient with standard precautions (unless the patient has additional transmission risk
factors e.g. diarrhoea), whilst awaiting results.
Doctors with patients identified of having CPE colonisation or infection are asked to:
Consider discussion with an infectious diseases physician or microbiologist, particularly to assist with
managing infection.
Manage patients in healthcare and residential caresettings with transmission based precautions.
Advise patients in general household settings of good hygiene measures including hand hygiene, using
own towels and personal grooming items, and covering wounds to minimise the spread of CPE

Further clinical information is available at SA Health multidrug-resistant organisms (MRO) web page:
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/healthcare+associated+infections/multidrug-resistant+organisms+mro
For all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days)
Dr Louise Flood – Director, Communicable Disease Control Branch
Public – I3-A2

Download the official health alert here (PDF)
 

Measles case in Adelaide - August 2019

01 August 2019 -  Measles case in Adelaide

SA Health has been notified of a case of measles in a 19-year-old woman from metropolitan Adelaide who acquired the infiction while in Europe. The woman was at the following locations listed while infectious:
Royal Adelaide Hospital Emergency Department on Wednesday 31 July between 6:30pm and 8:00pm.
Hampstead Health Family Practice, 1/237 Hampstead Road, Lightsview on Tuesday 30July between 12 noon and 1:10pm & on wednesday 31 July between 9:00am and 10:00 am.
Adelaide Metro Busses on Monday 29 July: Route 502 Gilles Plains to Adelaide City continuing as Route 110 to West Lakes between 11:15am and 12:15 pm, and route 502 Adelaide City to Salisbury Interchange and return to City between 1:15pm an 2:15pm.

  • Adelaide University Engineering Building, Adelaide on Monday 29 July between 12:00 noon and 1:30pm.
  • Tea Tree Plaza Shopping Centre, Modbury on Friday 26 July between 3:00pm and 5:30pm.
  • Barnacle Bill, 746 North East Road, Holden Hill, on Friday 26 July between 5:00pm and 6:10pm.

More

 

COMMUNICABLE DISEASE 
CONTROL BRANCH
- Attention all doctors - 
Date: 01/08/2019     Contact telephone number: 1300 232 272  (24 hours/7 days)

 

Measles case in Adelaide

 

SA Health has been notified of a case of measles in a 22-year-old woman from South Australia. The woman was at the following locations while infectious, and people in the vicinity may have been exposed:

  • Goodlife Gym Glenelg at 520 Anzac Highway, Glenelg, 15 April, from 6.00am - 7.30am.
  • Bomdia Bowls (health food/ smoothie bar) at 2B Moseley Street, Glenelg, 15 April, 8.00am-5.00pm.
  • Plympton Park Day & Night Surgery, 590-592 Marion Rd, Plympton Park, 17 April, 11.15am -12.30pm.
  • Blair Athol Medical Clinic & Pharmacy, 502 Main North Rd, Blair Athol, 23 April, 10.00am -10:30am.
  • Clinpath collection centre at Blair Athol Medical Clinic & Pharmacy, 502 Main North Rd, Blair Athol, 23 April, 10.00am -10:30am.

There have been 142 of measles cases reported in Australia this year. This is the 4th case of measles in a South Australian resident this year. The most recent case in July was a Queensland resident who spent some time in South Australia whilst infections.
Measles is transmitted via respiratory aerosols that remain a risk to others for up to 30 minutes after the person has left the area. The incubation period is about 10 days (range 7 to 18 days) to the onset of prodromal symptoms and about 14 days to rash appearance. The illness is characterised by cough, coryza, conjunctivitis, a descending morbilliform rash, and fever present at the time of rash onset. The infectious period is from 24 hours prior to onset of the prodrome until 4 days after the onset of the rash.
Doctors with patients suspected of having measles are asked to:

  • Notify urgently any patient with suspected measles to the CDCB on 1300 232 272 (24 hours/7 days). Do not wait for laboratory confirmation.
  • Arrange urgent laboratory testing through SA Pathology. Take throat swabs in viral transport medium for measles PCR (preferred specimen) and urine for measles PCR (yellow top container).
  • Isolate suspected and confirmed measles cases and exclude from child-care/ school/ workplace for 4 days after rash appearance.
  • Isolate all household and other contacts are protected against measles as indicated in the Australian Immunisation Handbook https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/measles
  • Minimise transmission of measles:
    • Examine patients suspected of having measles in their own homes wherever possible.
    • Ensure the patient is only seen by practice staff who have confirmed immunity to measles.
    • Ensure suspected cases do not use the waiting room, and conduct the consultation in a room that can be left vacant for at least 30 minutes afterwards.
    • Treat all people who attend the rooms at the same time as and up to 30 minutes after the infectious patient has left the rooms as contacts.

Measles vaccination(note measles vaccine is currently in short supply in Australia)

  • Two doses of a measles containing vaccine are highly effective at preventing measles. Offer measles vaccine (unless contraindicated, for example in pregnant women or immunosuppression) to all potentially susceptible persons who attend your practice.
  • While most people born in Australia before 1966 will have had measles in childhood, those born in the late 1960s to mid-1980s may have only received one measles vaccine.
  •  Vaccination against measles can now be given from 6 months of age in infants travelling to countries where measles is endemic or a measles outbreaks are occurring (if given <12 months, 2 subsequent doses will be required).

Further clinical information is available at www.sahealth.sa.gov.au/InfectiousDiseaseControl
For all enquires please contact the CDCB on 1300 232 272 (24 hours/7 days)
Dr Louise Flood – Director, Communicable Disease Control Branch
Public – I4-A1

Download the official health alert here (PDF)
 

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