Carbapenemase-Producing Enterobacterales (CPE)

These precautions help prevent the spread of CPE to other children, families and hospital staff. They are used in addition to our routine infection prevention practices, such as hand hygiene, covering the mouth when coughing or sneezing, and cleaning surfaces.

What are CPE?

Enterobacterales are a family of bacteria, many of which are naturally found in our intestines. Carbapenemase-producing Enterobacterales produce enzymes that can break down many types of antibiotics, making these bacteria highly resistant. Although there are currently few cases of CPE infection in Canadian hospitals, vigilance is still necessary to prevent their development and spread.

How do CPE spread?

Most people who carry CPE do not show symptoms of infection; they are considered colonized. The main site of CPE colonization is the intestines. CPE are not spread through the air, but they can survive on equipment and surfaces such as railings, tables, chairs, countertops and door handles. CPE can spread from one person to another through contact with contaminated hands, equipment or surfaces. An infection occurs when CPE enter certain parts of the body and cause symptoms of illness. For example, they can cause pneumonia or urinary tract infections. Because CPE are resistant to many types of antibiotics, treatment is difficult and may require the use of antibiotics that can have serious side effects.

Do CPE go away?

CPE colonization in the intestines can persist for a long time. There is no known or proven treatment to completely eliminate CPE from the body.

The gut microbiome plays a complex role in colonization. Disrupting it with unnecessary antibiotics can make the situation worse. That’s why antibiotics are used only to treat infections (in patients who show symptoms), and not to treat colonization. Most patients do not develop an infection.

Research is ongoing, but for now, infection prevention and good hygiene remain our best tools.

How can someone get CPE?

Currently, the main risk factor is hospitalization, even for a short stay, in healthcare facilities — especially hospitals — in countries where these bacteria are common, such as India, Pakistan, Greece, Israel and certain regions of the United States and France. Outbreaks of CPE have been reported in hospitals around the world, including in Canada.

People coming from Asia, including the Indian subcontinent, are also considered at risk, whether or not they have received care in healthcare facilities.

Other risk factors for acquiring CPE include:

• Having taken many antibiotics, especially carbapenems.
• Being connected to medical devices such as a urinary catheter or central line.
• Having a disease that weakens the immune system.
• Having had a previous infection with another resistant bacterium.
• Being in contact with someone who carries CPE, especially in a healthcare setting.

What additional precautions are required when caring for a patient with CPE?

The healthcare team will continue to provide the same quality of care to all patients. If CPE are detected in a patient, screening tests will be performed on patients in close proximity. Additional precautions will be taken to help prevent the possible spread of the bacteria.

These precautions include:

• A sign will be posted on the patient’s door to remind staff and visitors of the special precautions required before entering (e.g., wearing a gown and gloves).
• Everyone, including parents and visitors, must wash their hands when leaving the room.
• The child’s medical record will include a note indicating CPE status.

What about family and visitors?

Healthy family members and visitors are at low risk of infection from CPE. Therefore, visits are allowed, but it is recommended to limit them to family and friends whose presence is considered necessary.

All visitors must receive instructions from staff about the additional precautions to follow. Children and infants must be closely supervised.

All family members and visitors are asked to:

• Wash their hands before entering and when leaving the room.
• Not use the patient’s bathroom.
• Not eat or drink in the patient’s room.

Good hand hygiene practices

Hand hygiene is the simplest and most effective way to prevent the spread of germs. Washing hands with soap and water or using an alcohol-based hand sanitizer are both effective methods. Feel free to remind staff and visitors to practice good hand hygiene before and after providing care.

Hands should be washed:

• When entering the room.
• Before and after caring for your child.
• After using the toilet.
• After blowing your nose.
• Before eating or drinking.
• Before and after wearing protective equipment (for example: a mask).
• Before and after touching dressings or wounds.
• When hands are visibly soiled.
• Every time you leave the room.

Please watch this hand hygiene video, created for you with the help of patients and families from the Montreal Children’s Hospital (MCH):

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What happens at home?

• It is important to wash your hands frequently, for twenty seconds each time, especially after using the bathroom or before preparing food.
• No special cleaning of household items (for example: dishes) or furniture is required.
• Clothing can be washed normally, along with the rest of the household laundry.

If you visit another healthcare facility, see another doctor or receive home care, you must inform them that you or your child are a carrier of CPE. This allows staff to take additional precautions when providing care.

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The information on this page was written in October 2025 by the Infection Prevention and Control Advisors at the MCH. It is based on publications from the Ontario Agency for Health Protection and Promotion (Public Health Ontario) and the Institut national de santé publique du Québec.