Treatment and antibiotic resistance: CPE are resistant to the carbapenems, the last effective drug left to treat many multidrug-resistant Gram-negative rods. This makes infections with CPE difficult to treat, and reliant on older, less effective and less well-tolerated antibiotics, such as colistin (Nordmann, Naas et al. 2011). Ominously, pan-drug resistant strains have been reported (Bogdanovich, Adams-Haduch et al. 2011).
Disease and symptoms: CPE can be carried as part of the normal gut flora without any symptoms or cause infections. CPE have the capacity to cause infections at a wide range of body sites, including urinary tract infections, wound infections and occasionally bloodstream infections. The attributable mortality associated with CPE infections is very high, and can exceed 50% (Snitkin, Zelazny et al. 2012). CPE have emerged in recent years as a global public health threat (Nordmann, Naas et al. 2011). Several countries (such as Greece and Italy) now have endemic CPE problems, whereas the prevalence in most parts of the world is low but increasing sharply. CPE are currently emerging as a series of outbreaks in the USA, UK and elsewhere in Europe.
Prevention and control: In terms of preventing the spread of infection in healthcare settings, measures such as hand hygiene compliance, environmental decontamination, prompt identification and strict isolation of carriers, enhanced surveillance, improved antibiotic stewardship and screening of patients that have been transferred or have recently returned from overseas hospitals should reduce the transmission of CPE strains (Palmore and Henderson 2013). However, effective control measures to prevent the spread of CPE in hospital and community settings require urgent research.
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