healthcare-associated infections (hai) program

Carbapenem-resistant and Carbapenemase-producing Organisms for Patients and Families

Carbapenemase-producing organisms (CPOs) are bacteria that are resistant to antibiotics called carbapenems (e.g., meropenem, ertapenem, imipenem). CPOs include carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB). Common carbapenemases include NDM, KPC, VIM, OXA, and IMP.

Frequently Asked Questions

Why are CPOs a problem?

Identification of patients with CPOs is becoming more common throughout California. These germs can spread from patient-to-patient in healthcare settings like hospitals and nursing homes. CPO infections are difficult to treat because they can be resistant to most antibiotics.

Who is at risk of getting a CPO?

In general, healthy people are not at risk of getting a CPO. People who have spent time in healthcare facilities, like hospitals or nursing homes, are most at risk of becoming carriers (colonized) of a CPO and developing infections.

Risk factors for getting a CPO include:

Being on a mechanical ventilator (breathing machine)
Having indwelling medical devices such as urinary catheters or endotracheal (breathing) tubes
Having wounds from surgery or burns
Taking long courses of certain antibiotics
Recent stay at a long-term acute care hospital or a ventilator-equipped skilled nursing facility
Recent overnight stay at a healthcare facility outside of the United States
Having a weakened immune system

How are CPOs spread?

There are different ways CPOs can spread. These include:

Person-to-person contact from dirty hands, wounds, or stool (poop)
Contaminated medical equipment or surfaces
Medical devices for treatment of other conditions, such as endoscopes
During surgery or other invasive procedures
A few reports have described spread between animals and humans and animal-to-animal spread. Find more information on CDC’s website.

Spread can happen whether a patient has an active infection or is just a carrier of a CPO (colonization). While healthcare providers can be responsible for the spread of CPOs (through contaminated hands or clothing), they themselves are not generally at risk of carrying or being infected with these germs.

What can patients and families do to prevent CPO infections?

Patients and families can take several important steps to help lower their chances of getting a CPO infection, including to:

Tell your doctor if you have ever been diagnosed with a drug-resistant infection, or hospitalized elsewhere, especially outside of the United States.
Take antibiotics exactly as your healthcare provider instructed.
Expect all healthcare providers to wash their hands with soap and water or use an alcohol-based hand sanitizer before and after touching your body, or tubes going into your body. If they do not, ask them to do so.
In many healthcare settings, healthcare providers will wear gloves and gowns when interacting with patients with a CPO.

If you have a CPO, or are caring for someone who does, make sure to clean your own hands and practice good hygiene. This is especially important during the following activities:

Before preparing or eating food
After using the bathroom
Before and after changing wound dressings or bandages
After blowing your nose, coughing, or sneezing

Should family members or other close contacts of patients be tested for a CPO?

CDPH does not recommend family members or otherwise healthy close contacts of patients with CPOs be tested. In general, healthy people are not at risk of getting a CPO and do not need to be tested.

What can healthcare facilities and public health do to prevent CPO spread?

Preventing the spread of CPOs, and other multidrug-resistant organisms is essential to patient safety and ensuring antibiotics continue to work in the future. Healthcare providers and public health practitioners can visit the CDPH webpage for CPOs to learn about how healthcare facilities and public health departments can prevent spread of these drug-resistant germs. Local health departments can view the CDPH CPO Quicksheet (PDF) when working with healthcare facilities to prevent CPO spread in their jurisdictions.