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CPO - surveillance and isolate referral forms

Key messages

  • All suspected and confirmed isolates of CPO from both human and environmental samples are required to be referred to Microbiological Diagnostic Unit Public Health Laboratory (MDU PHL) for confirmatory testing.
  • As of January 2025, the CPO surveillance data collection form is now available to complete online. This is the preferred way to complete the surveillance form.
  • A printable version of the form remains an option to complete and fax to the department. If using the printable form, please ensure it is the updated version.

CPO surveillance data collection forms

The CPO surveillance data collection form is to be used for all confirmed human CPO isolates. This can be completed either via the secure online form or by faxing the printable version to the department on 1300 651 170.

The CPO surveillance data collection form was updated in April 2025. If using the printable form, please ensure it is the updated version.

Enquiries may be directed to amr.secretariat@health.vic.gov.au

CPO surveillance form
PDF 197.25 KB
(opens in a new window)

CPO isolate referral forms (human and environmental)

The following forms are to be used by diagnostic laboratories when referring any CPO isolates to the Microbiological Diagnostic Unit Public Health Laboratory (MDU PHL). Note that there are different forms for human and environmental isolates.

Carbapenem resistant human isolate referral form FM2458
PDF 610.51 KB
(opens in a new window)
Carbapenem resistant environmental isolates referral form FM2699
Excel 30.96 KB
(opens in a new window)

Updated