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CPE Infections: What They Are and Why They Matter to Us All

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Antibiotic Resistance, Carbapenemase-Producing Enterobacterales (CPE), Microbiology
July 25, 2025

This blog post explores Carbapenemase-Producing Enterobacterales (CPE), a subset of multidrug-resistant organisms that continue to challenge infection prevention and antimicrobial stewardship.

What are CPE infections?

Carbapenemase-Producing Enterobacterales (CPE) are a group of bacteria that have developed resistance to some of our strongest antibiotics: carbapenems (CDC 2024).

CPE belongs to a larger group of bacteria called Enterobacterales, which include common types like Escherichia coli and Klebsiella pneumoniae. While these bacteria can normally live harmlessly in our gut, some CPE can colonise the body silently, especially the gut, or cause serious infections, such as bloodstream infections, pneumonia or urinary tract infections (UTIs) (NHS 2024). What makes them especially dangerous is that they produce enzymes (carbapenemases) that break down antibiotics, making treatment very difficult or, in some cases, ineffective (Tilahun et al. 2021).

Beyond the basics: why are CPE so dangerous?

CPE are part of a broader group known as multidrug-resistant organisms (MDROs). These organisms have developed resistance to multiple classes of antibiotics. Once carbapenems fail, physicians are left with fewer antibiotic choices. Meanwhile, individuals colonised with CPE may show no symptoms, enabling bacteria to spread unnoticed (CDC 2023; NHS 2024). CPE typically spreads person-to-person via contact from dirty hands, wounds or stool, and contaminated medical equipment and devices (CDC 2024).

Colonisation vs. infection: what is the difference?

Colonisation with carbapenem-producing Enterobacterales (CPE) refers to the presence of the bacteria on or in the body, such as on the skin, in the gastrointestinal tract, or other mucosal surfaces, without causing signs or symptoms of disease. This represents a carrier state, in which the individual can potentially transmit the bacteria to others or develop an infection later.

Infection, on the other hand, occurs when the colonising CPE breach host defences and multiply in normally sterile body sites, leading to tissue damage and clinical symptoms. This represents an active disease process, requiring appropriate medical intervention.

Understanding whether someone is colonised (carrying CPE, often without symptoms) or infected (showing illness caused by CPE) is important. Colonised individuals are not sick but can transmit CPE (CDC 2023).

Patients who have multiple hospital admissions or treatments for example are dialysis dependent or have had cancer chemotherapy in last 12 months are at high-risk for colonisation and or infection with CPE (UKHSA 2023).

Early detection is key: screening, diagnostics, surveillance

Screening helps identify carriers of CPE early, especially for those transferred from high-risk settings or who have a history of resistant infections and during contact tracing, enabling early outbreak situations (Jenkins et al. 2024). Modern tools combine culture techniques and rapid molecular tests (PCR), with the latter able to detect resistance genes within hours (UKHSA 2023). Diagnosis may confirm colonisation or active infection and if needed, guide treatment based on resistance profile.

Surveillance is vital for ongoing monitoring of CPE and other resistant organisms. Surveillance allows public health agencies to:

  • Detect outbreaks early
  • Understand how resistance is spreading
  • Evaluate infection control strategies
  • Inform clinical guidance and antibiotic policy

In the UK, the UK Health Security Agency (UKHSA) leads this surveillance effort. Globally, organisations such as the WHO and ECDC play a key role in monitoring resistance trends and sharing best practice (UKHSA 2023; WHO 2020; ECDC 2023).

Why does it matter to patients and the community?

Being identified as a CPE carrier can impact patient care, even if patients feel perfectly well. Patients might be placed in a single room to minimise the risk of spreading the bacteria to others. Healthcare staff may take additional precautions such as wearing gloves and gowns. While this might feel isolating, these measures are designed to protect everyone. Awareness of colonisation helps clinicians plan safer care, especially before surgeries or treatments that suppress immunity. Importantly, CPE screening is a proactive measure, not a judgement, and it plays a key role in stopping the spread of these bacteria (UKHSA 2023).

What can healthcare professionals do?

Healthcare professionals are central to controlling the spread of CPE. This includes implementing local screening protocols, maintaining strict hand hygiene, using personal protective equipment, and ensuring thorough cleaning of equipment and environments. They also have an important role in educating patients about CPE and reducing stigma. Furthermore, healthcare workers contribute to surveillance by reporting cases and participating in monitoring programmes that help shape national and international policies (UKHSA 2023; CDC 2023).

From a “One Health” perspective

From a One Health perspective, CPE pose a critical and escalating threat due to their capacity to disseminate across human, animal, and environmental domains. Resistance genes, often harboured on mobile genetic elements such as plasmids, can readily transfer between bacterial species and even across genera, compounding the challenge of containment. This horizontal gene transfer facilitates the emergence of multidrug-resistant organisms in diverse ecosystems, undermining infection prevention efforts and therapeutic options. Addressing the CPE threat requires a coordinated, multisectoral response that integrates surveillance, stewardship, and biosecurity measures across human health, veterinary medicine, agriculture, and environmental management (Martel et al. 2025; Ramírez-Castillo et al. 2023).

What can we do?

  • Adhere to hand hygiene protocols
    Use hand sanitiser or wash with soap and water before and after every patient contact.
  • Implement contact precautions
    Follow infection control guidance when caring for CPE-positive patients, including use of gloves, gowns, and dedicated equipment where needed.
  • Screen high-risk patients
    Ensure screening is carried out for patients recently hospitalised elsewhere or transferred from long-term care facilities.
  • Prescribe antibiotics responsibly
    Use carbapenems and other broad-spectrum antibiotics only when clearly indicated and do not use carbapenems without a susceptibility assessment. Work with microbiology and stewardship teams to guide decisions.
  • Educate patients and families
    Help people understand why precautions are in place and what they can do to support infection prevention.

These may seem like small actions, but they really do make a difference for your own health, and for everyone else’s.

AMR: Antimicrobial resistance
CPE: Carbapenemase-producing Enterobacterales
Colonisation: When bacteria are present in the body but not causing illness.
Infection: When bacteria cause symptoms or disease in the body.
IPC: Infection prevention and control
MDRO: Multidrug-resistant organism
PCR: Polymerase chain reaction

 

Demi Christofi

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Demi is an Associate Scientific Director at a medical communications agency, with a background in microbiology and a longstanding focus on antimicrobial resistance. She holds an MSc in Microbiology, where she first became interested in the global challenge of resistance and the need to bring scientific understanding to wider audiences.

Demi’s career has centred on a simple but powerful belief: that how we communicate science matters. Her work focuses on making complex data clear, engaging, and accessible – whether for healthcare professionals, policy makers, or the patients most affected by infection and resistance. She has contributed to a wide range of AMR-focused projects, including educational programmes, congress communications and stewardship initiatives.

A central thread in Demi’s work is the importance of the patient voice. She is passionate about making sure real-world experiences of treatment failure, recurrent infections, and the anxiety surrounding resistance are not lost in the data. She believes that listening to patients and involving them meaningfully is essential for shaping more effective, human-centred responses to AMR.

Demi is also a strong advocate of the One Health approach, recognising AMR as a complex, interconnected issue that spans human health, animal health, and the environment. She is particularly drawn to efforts that move beyond siloed thinking and focus on practical, joined-up solutions.

In 2025, Demi joined The AMR Narrative as an Independent Advisor, where she supports the charity’s mission to centre communication, community, and inclusion in the global AMR response.

Outside of work, she is a Girlguiding unit leader and a qualified yoga teacher. These roles reflect her commitment to care, learning, and creating supportive spaces for others.

Disclaimer: The information provided on this website is intended for educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Reliance on any information provided on this website is solely at your own risk. The website owners and authors are not responsible for any errors or omissions in the content or for any actions taken based on the information provided. It is recommended that you consult a qualified healthcare professional for individualised medical and health-related guidance.

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