Carbapenemase-producing Enterobacteriaceae (CPE)

What are CPE?

Enterobacteriaceae are a group of bacteria (germs), many of which live naturally in our bowels.  These germs are also found in the environment.  CPE is a type of enterobacteriaceae that makes carbapenemase enzymes.  These enzymes can break down many types of antibiotics (medications that fight bacteria).  This makes the bacteria very resistant and hard to treat. 

Most people can carry CPE in their bowels without it causing them any harm or symptoms.  This is called “colonization”. When the bacteria cause symptoms and make you sick, we call it an infection.  CPE can cause serious infection if the germs get into other areas of your body, such as the lungs, bladder, or bloodstream.

What are the symptoms of CPE?

When people get CPE, we do not know how long it takes before symptoms start to show.  Most people do not have symptoms if colonized with CPE.  Symptoms vary depending on where in the body the infection is.  It can cause a urinary tract infection (infection of the place where urine/pee is made and removed from the body.  It can also cause bacteremia (infection of the blood).  CPE can also infect the lung, causing pneumonia (inflammation of the lungs).

How does CPE spread?

CPE can be spread directly or indirectly from person to person by:

  • Touching contaminated surfaces or medical equipment that have the bacteria on it, such as door handles, bed rails, and tables; and/or
  • Unclean hands that can carry the germ. Health care workers and visitors can spread it to other patients if they do not clean their hands properly.

People most at risk for colonization or infection are those who:

  • Have been in physical contact with a person who has CPE.
  • Stay in hospitals and other health care facilities that have CPE, especially those outside Canada Are from the Indian subcontinent (e.g., India, Pakistan, Bangladesh);
  • Have been treated often with antibiotics in the past; and/or
  • Do not have a strong immune system (body’s ability to fight off infections).

How long is it contagious?

A person can pass the germ to others as long as the germ lives in their bowels.  A person may live with CPE for months to years.

How are CPE treated?

Treatment depends on the type of CPE and the location of the infection.  CPE can be very hard to treat as most antibiotics are resistant. People with CPE may need strong antibiotics or have to take more than one antibiotic which may result in significant side effects.  A person colonized with CPE does not need treatment.

How do I prevent the spread of CPE?

Ways to prevent colonization or infection of CPE include:

  • Wash your hands often for at least 15 seconds with warm water and soap, especially before and after preparing foods, before eating, and after handling diapers and using the washroom.  This is the best way to prevent the spread of CPE.  If using alcohol-based hand rub, rub your hands until dry.
  • If you work in or visit a health care facility, follow precautions asked of you by the facility.  Wear gloves and gown when caring for a patient with CPE or if in contact with his/her environment.  Patients with CPE should have dedicated equipment for their use only. Wash your hands properly before and after care and before leaving the room. Properly clean and disinfect surfaces and equipment.
  • Avoid unnecessary visits to health care facilities in countries that have CPE.
  • Inform your health care providers if you had a medical procedure done or received treatment while travelling.  This allows them to assess your risk for CPE, and take steps to prevent the spread of CPE.

If I have CPE, what happens when I go home?

  • Wash your hands often for at least 15 seconds with warm water and soap, especially before and after preparing foods and after using the washroom.
  • No special cleaning of items in your home (e.g., dishes) is needed.
  • Wash soiled clothes.  They do not need to be separated from other laundry.
  • If you go to another health care facility, visit another doctor or have people come to your home to provide health care services, you should tell them you have CPE. They may use additional precautions when providing care, which will help prevent spread to others and help your doctor choose the right antibiotic for your treatment.

For more information

contact the Health Unit or speak to your health care provider.


  • Ministry of Health and Long-Term Care. (2019). Infectious Diseases Protocol: Appendix A – Carbapenemase-producing Enterobacteriaceae (CPE) infection or colonization. Retrieved from
  • Ontario Agency for Health Protection and Promotion, Provincial Infectious Diseases Advisory Committee. (2013). Annex A – Screening, testing and surveillance for antibiotic-resistant organisms (AROs). Annexed to: Routine Practices and Additional Precautions in All Health Care Settings. Toronto, ON: Queen’s Printer for Ontario.