Carbapenemase-producing Enterobacterales in the hospital water environment: a narrative review

Carbapenemase-producing Enterobacterales (CPE) have emerged as critical threats to global health. These bacteria are increasingly responsible for challenging outbreaks within hospital settings, leading to increased morbidity and mortality rates. They can be found in hospital water environments, where their presence may pose significant risks for patient acquisition, potentially facilitating transmission through direct and indirect contact.

This narrative review aimed to summarize current knowledge regarding CPE in the hospital water environment, elucidate their role in patient acquisition, and evaluate effective decontamination strategies.

A comprehensive literature search was conducted using the PubMed database, identifying studies published from inception to July 2025. Additionally, manual reference checks were performed to ensure thorough coverage of relevant literature.

CPE are commonly detected in the hospital water environment, particularly in sinks, toilets, and shower drains. Evidence suggests a reciprocal relationship between environmental contamination by CPE and patient acquisition. Various decontamination methods, including chemical and thermal treatments as well as reservoir replacement, have been explored. Although some methods demonstrate efficacy, they often present challenges related to implementation and sustainability.

Addressing CPE in the hospital water environment is crucial for preventing outbreaks and protecting patient safety. Implementing comprehensive infection control measures and environmental cleaning protocols could significantly reduce the risk of CPE transmission, ultimately improving patient outcomes and public health. The findings underscore the need for ongoing research to better understand contamination dynamics and the effectiveness of decontamination strategies.