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

Published online by Cambridge University Press:  02 January 2015

Ramya Gopinath
Affiliation:
Infectious Diseases and Hospital Epidemiology and Infection Control, Howard County General Hospital, Columbia, Maryland
Patrice Savard
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Healthcare Epidemiology and Infection Prevention, Johns Hopkins Health System, Baltimore, Maryland
Karen C. Carroll
Affiliation:
Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
Lucy E. Wilson
Affiliation:
Prevention and Health Promotion Administration, Infectious Disease Bureau, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
B. Mark Landrum
Affiliation:
Infectious Diseases and Hospital Epidemiology and Infection Control, Howard County General Hospital, Columbia, Maryland
Trish M. Perl
Affiliation:
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland Healthcare Epidemiology and Infection Prevention, Johns Hopkins Health System, Baltimore, Maryland
Corresponding
E-mail address:

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.

Type
Research Briefs
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

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.Google Scholar
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.Google Scholar
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