Blog | Friday, February 17, 2017

Pan-resistant NDM-containing K. pneumoniae lacking MCR-1


I wanted to let you know about a new case report in MMWR while simultaneously raising the MMWR Altmetric Score. Seriously, how can such a case only have one blog mention in 24 hours—Jon Otter must be just getting back from holiday.

The Centers for disease Control and Prevention has reported a case of New Delhi metallo-beta-lactamase (NDM-1)–containing carbapenem-resistant Enterobacteriaceae (CRE) and Klebsiella pneumoniae isolated from a wound specimen of a woman in her 70s who had returned to the U.S. after a log visit to India. She also reported prior visits with multiple hospitalizations in India. The isolate was resistant to the 26 antibiotics tested, including all aminoglycosides and polymyxins (despite being MCR-1 negative), while it was intermediately resistant to tigecycline. The fosfomycin MIC was 16 μg/mL. Unfortunately, the patient developed sepsis and died. Fortunately, the patient had been isolated and screening revealed no evidence of transmission.

CDC offered three take home points:

Most CRE remains susceptible to at least one aminoglycoside or tigecycline,

When patients with this highly resistant organisms are identified, they should be placed under contact precautions*, and

Facilities should obtain travel histories and consider screening for CRE if patients are from high-risk areas.

*Note: nice to see that somebody still loves contact precautions.

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.