ENTEROBACTERIACEAE - USA ex GREECE: FIRST REPORT
What is Enterobacteriaceae? - http://en.wikipedia.org/wiki/Enterobacteriaceae
More info from CDC; http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5924a5.htm?s_cid=mm5924a5_w
Update: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e0921a1.htm?s_cid=mm59e0921a1_w
********************************************************
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 21 Sep 2010
Source: CDC. MMWR Morb Mortal Wkly Rep 2010; 59 (early release); 1-1 [edited]
In July 2010, CDC was notified of a patient with a
carbapenem-resistant _Klebsiella pneumoniae_ strain that produced a
Verona integron-encoded metallo-beta-lactamase (VIM) carbapenemase
(1) not reported previously among _Enterobacteriaceae_ in the USA.
The patient was a woman from the USA who became ill with diarrhea
during a Mediterranean cruise and was hospitalized in Greece, where
she received a diagnosis of sepsis and _Clostridium difficile_ infection.
After 12 days in 2 hospitals in Greece, she was transferred to a
hospital in the USA for continued management of sepsis and acute
renal failure. On admission, blood was drawn for culture through a
central venous catheter that had been placed while the patient was
hospitalized in Greece. The blood subsequently grew
carbapenemase-producing _Klebsiella pneumoniae_ exhibiting the VIM
resistance mechanism, which has been described previously in Greece
but not in the USA. Further testing showed the isolate to be non
susceptible to all antimicrobials usually used to treat _Klebsiella_.
Despite the resistance of the _Klebsiella_ strain, the patient
recovered sufficiently to be discharged after 26 days in the American
hospital. A search for other patients colonized with the same isolate
was conducted by screening 22 patients whose hospital stays
overlapped with this patient; no carbapenem-resistant
_Enterobacteriaceae_ (CRE) were detected.
This report of a VIM-producing CRE follows a June 2010 report of 3
cases of New Delhi metallo-beta-lactamase (NDM-1)-producing
_Enterobacteriaceae_ (2). However, the most common mechanism of
carbapenem resistance among _Enterobacteriaceae_ in the USA remains
the production of the _Klebsiella pneumoniae_ carbapenemase (KPC).
KPC-producing _Enterobacteriaceae_ are widespread in the USA and
other countries (3). Cases of CRE are a significant, emerging public
health problem regardless of the mechanism of carbapenem resistance,
and procedures to rapidly recognize and report CRE cases to infection
prevention personnel should be in place in all acute and
long-term-care facilities. Facilities that have not identified cases
of CRE should undertake periodic laboratory reviews to identify
cases. Patients with CRE should be managed using contact precautions,
and patients exposed to CRE patients (such as roommates) should be
screened with surveillance cultures (3). State and local health
departments should promote adoption of current prevention guidance
and monitoring of the prevalence of these organisms in their jurisdictions (3).
Public health officials and health-care facility staff can consult
with the Division of Healthcare Quality Promotion at CDC on the best
practices for identifying and preventing transmission of these
organisms (e-mail:
References
----------
1. Vatopoulos A: High rates of metallo-beta-lactamase-producing
_Klebsiella pneumoniae_ in Greece -- a review of the current
evidence. Euro Surveill 2008; 13(4): 1-6 [available at
2. CDC: Detection of _Enterobacteriaceae_ isolates carrying
metallo-beta-lactamase -- United States, 2010. MMWR 2010; 59(24): 750
[available at
3. CDC: Guidance for control of infections with carbapenem-resistant
or carbapenemase-producing _Enterobacteriaceae_ in acute care
facilities. MMWR 2009; 58(10): 256-60 [available at
--
Communicated by:
ProMED-mail
[The Verona integron-encoded metallo-beta-lactamase carbapenemases
(VIM-1 and VIM-2) were initially identified in carbapenem-resistant
_Pseudomonas aeruginosa_ in the Mediterranean basin. The VIM-1 gene
was originally cloned from a _P. aeruginosa_ strain from an outbreak
in the ICU of the University Hospital in Verona, Italy, hence the name.
Bacteria containing this enzyme have a very broad substrate range
including the carbapenems and most other beta-lactams. The enzymes
are encoded on mobile gene cassettes which have been inserted into an
integron. The integrons easily spread between organisms, playing a
major role in the spread of antimicrobial resistance in gram-negative bacilli.
This resistance gene is the 3rd to be highlighted in the news over
the past 6 weeks. - Mod.LL]
[see also:
NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan (02)
20100914.3325
NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan 20100817.2853
NDM-1 carrying Enterobacteriaceae - N America, UK ex India 20100815.2812
E. coli ST131 - USA: emerging drug-resistant pathogen worldwide 20100803.2607
Antimicrobial resistance monitoring - USA: 2007 report 20100506.1471
2007
----
E. coli, ESBL - UK 20071106.3614
2004
----
E. coli, ESBL - UK (Shropshire) (02) 20040718.1952
E. coli, ESBL - UK (Shropshire) 20040715.1920
2003
----
Acinetobacter, drug resistant - Iraq: RFI 20030417.0934
2002
----
Gram negative bacilli, ESBL - UK (Scotland) 20020527.4333]
...................................mpp/ll/mj/mpp
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
************************************************************
Visit ProMED-mail's web site at
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at
For assistance from a human being, send mail to:
############################################################
############################################################
No comments:
Post a Comment