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| Courtesy: YouTube |
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).
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| 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:
