A Comprehensive Look at Carbapenemase-Producing Enterobacterales (CPE): An Urgent and Emerging Threat Posed by Carbapenemase Production

In this chapter, we will explore and review published data on carbapenemase-producing Enterobacterales. Since the first published report of Klebsiella pneumoniae carbapenemase (KPC), other reports of carbapenemase enzymes have been reported globally and, by extension, from the English-speaking Caribbean. Several enzymes have been reported since the detection of KPC including oxacillinase (OXA)-48 like carbapenemase, Guiana extended-spectrum (GES) carbapenemase, New Delhi metallo-beta-lactamase (NDM), Verona integron-encoded metallo-beta-lactamase (VIM), and others. The ability to detect the carbapenemase enzyme is largely dependent on available infrastructure. Due to resource limitations, most centres have to rely on phenotypic tests and often are unable to describe at a molecular level the nature of the underlying carbapenemase genes. Regardless, in this report, we will do an extensive review of the literature to see what current reports are of these enzymes. This review will address the epidemiology and etiology of carbapenemase-producing Enterobacterales (CPE), a subset of carbapenem-resistant Enterobacterales (CRE); detection methods; management; and recommended treatments of CP-CRE and infection prevention and control (IPC) strategies for managing CP-CRE. The primary source of information will be through a review of published literature to date.