Pan resistant CRE strain claims life of a Nevada woman who was traveling back from India.

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The Washoe County Health District in Reno, Nevada was notified of a 70-year-old woman in whom carbapenem-resistant Enterobacteriaceae (CRE) was identified from a wound specimen collected from the women on August 19, 2016. The woman has returned from India after an extended stay and had a history of multiple hospitalization related to a right femur fracture and subsequent osteomyelitis of the right femur and hip. Her last hospitalization was in June 2016.

The report was published in January 13 issue of the Morbidity and Mortality Weekly Report.

After her arrival, here she was admitted to the acute care hospital on August 18 with a primary diagnosis of systemic inflammatory response syndrome, likely resulting from an infected right hip seroma. The patient developed septic shock and died in early September. 

Culture and sensitivity of the specimen identified the bacteria as  Klebsiella pneumoniae, that was resistant to 26 antibiotics, including all aminoglycosides and polymyxins tested. It was intermediately resistant to tigecycline, a tetracycline derivative designed to counteract antibiotic resistance. CDC confirmed it as New Delhi metallo-beta-lactamase (NDM).

The superbug 

The strain was negative for mcr-1 gene, that confers plasma mediated resistance to colistin. A survey for prevalence of the species in all other occupants of the ward during the patient admission to the hospital did not identify additional CREs.

CREs are urgent threat in the US because of more than 50% mortality, no effective treatment and danger of spreading the infection.

Emerging Infections Program by CDC has so far collected more than 250 specimen reports but none are resistant to all antibiotics, approximately 80% remained susceptible to at least one aminoglycoside and nearly 90% were susceptible to tigecycline. A recent report by CDC on CRE Infections, have reported 175 cases of NDM-producing 

Carbapenem-resistant Enterobacteriaceae (CRE).

This case also highlights the importance of contact precaution and patient isolation when a CRE isolate is identified. It also stresses the importance of through history taking, specially travelling and hospitalization outside US.

India and China are known to have higher incidence of   NDM CRE strains of CRE. Although, CRE infections are not notifiable nationally in US.

Source:

CDC's  Morbidity and Mortality Weekly Report.