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Infection Prevention Considerations Related to New Delhi Metallo-β-Lactamase Enterobacteriaceae A Case Report

  • Ramya Gopinath (a1), Patrice Savard (a2) (a3), Karen C. Carroll (a4), Lucy E. Wilson (a5), B. Mark Landrum (a1) and Trish M. Perl (a2) (a3)...

Extract

A 60-year-old American man who was hospitalized in India for 4 weeks after an intracranial bleed was transferred by air ambulance to a 249-bed community hospital in Maryland in January 2011. His clinical course is described elsewhere. Here, we describe the infection prevention considerations surrounding his care in the hospital. A sputum sample obtained from the patient grew a New Delhi metallo-β-lactamase-producing (NDM) Klebsiella pneumoniae (NDM-KP) strain and panresistant Acinetobacter species, among other pathogens. Two weeks later, a perirectal swab sample grew an NDM-1 Salmonella Senftenberg (NDM-SS) isolate, described elsewhere. Gut decolonization was attempted with rifaximin 300 mg every 12 hours for 12 days. The patient was discharged home 4.5 months later. He was readmitted to the hospital within 1 week and died shortly thereafter.

In recognition of his epidemiological risk factors, empiric contact isolation was instituted by the infectious disease physician who was consulted when the patient experienced a fever 24 hours after hospital admission. Once the NDM-KP strain was identified, a 1:1 nursing protocol was instituted for the patient; respiratory therapists, however, continued to care for other Patients. The patient's nurses were empowered to enforce strict contact isolation. Visitors were restricted to the patient's immediate family members. The hospital implemented an intensive education and communication program for the professional staff, nurses, respiratory therapists, ancillary personnel, and the patient's family.

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Corresponding author

Infectious Diseases, Hospital Epidemiology/Infection Control, 2850 North Ridge Road, Suite 203, Ellicott City, MD 21043 (ragopinath@yahoo.com)

References

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1. Savard, P, Gopinath, R, Zhu, W, et al. First NDM-positive Salmonella sp. strain identified in the United States. Antimicrob Agents Chemother 2011;55(12):59575958.
2. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing-Twenty-First Informational Supplement. Wayne, PA: CLSI, 2011. CLSI document M100-S21.
3. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17(10): 17911798.
4. Nordmann, P, Poirel, L, Walsh, TR, Livermore, DM. The emerging NDM carbapenemases. Trends Microbiol 2011;19(12):588595.
5. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53(1):6067.
6. Patel, G, Bonomo, RA. Status report on carbapenemases: challenges and prospects. Expert Rev Anti Infect Ther 2011;9(5): 555570.
7. Centers for Disease Control and Prevention. Guidance for control of carbapenem-resistant Enterobacteriaceae (CRE): 2012 CRE toolkit. http://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf. Accessed November 16, 2012.

Infection Prevention Considerations Related to New Delhi Metallo-β-Lactamase Enterobacteriaceae A Case Report

  • Ramya Gopinath (a1), Patrice Savard (a2) (a3), Karen C. Carroll (a4), Lucy E. Wilson (a5), B. Mark Landrum (a1) and Trish M. Perl (a2) (a3)...

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