Carbapenem-resistant enterobacteriaceae containing New Delhi metallo-beta-lactamase in two patients - Rhode Island, March 2012

Morbidity and Mortality Weekly Report 06/2012; 61(24):446-448.
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    • "NDM-1 was initially discovered in India, first reported by UK scientists, and has received plenty of attention in India and the UK, and is emerging in the USA. By September 2011, there were 143 NDM-1 cases in India, 88 cases in the UK (Health Protection Agency, 2011), and 13 cases in the USA (Hardy et al., 2012). 2. Fung et al. (2011) investigated an additional risk characteristic in their study of news coverage of avian flu: catastrophic potential. "
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    ABSTRACT: Marrying the psychometric paradigm with the community structure theory, this paper examines the coverage of a superbug (NDM-1) in newspapers in India, the UK, and the USA. It identifies several community structure characteristics: level of vested economic interest, level of health care available, and size of health care stakeholders as factors influencing how risks of NDM-1 are portrayed in terms of the level of dread, controllability, familiarity, and uncertainty. The finding provides baseline data for the scientific community and public health professionals in creating more effective messages to inform the public about the risks of superbugs.
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    ABSTRACT: The emergence of carbapenem-resistant Enterobacteriaceae (CRE) highlights the importance of effective antibiotics to maintain the safety of our health care system. Clinicians will encounter CRE as a cause of difficult-to-treat and often fatal infections in hospitalized patients. We review the mechanisms of carbapenem resistance, the dissemination and clinical impact of these resistant organisms, and challenges to their detection, treatment, and control.
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    ABSTRACT: Overseas travel, as a risk factor for the acquisition of infections due to antimicrobial-resistant organisms, has recently been linked to carbapenemase-producing Gram-negative bacteria. Multiresistant Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii strains were isolated from a wound of a Canadian patient with a recent history of hospitalization in India. This resulted in the initiation of outbreak management that included surveillance cultures. Epidemiological and molecular investigations showed that NDM-1-producing K. pneumoniae ST16 and OXA-23-producing A. baumannii ST10 strains were transmitted to 5 other patients, resulting in the colonization of 4 patients and the death of 1 patient due to septic shock caused by the OXA-23-producing A. baumannii strain. The high rate of false positivity of the screening cultures resulted in additional workloads and increased costs for infection control and clinical laboratory work. We believe that this is the first report of an infection with carbapenemase-producing Gram-negative bacteria resulting in death attributed to a patient with recent foreign hospitalization. We recommend routine rectal and wound screening for colonization with multiresistant bacteria for patients who have recently been admitted to hospitals outside Canada.
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