Есть что улучшить? Предложите правку.
Bacteria that resist carbapenem antibiotics — carbapenem-resistant Enterobacteriaceae (CRE) — are often hard to treat and can spread quickly in health care settings. In December 2018, Washington state found a particularly worrying example.
The case
On December 31, 2018, the Antibiotic Resistance Laboratory Network alerted Public Health — Seattle & King County about a carbapenem-resistant Klebsiella pneumoniae cultured from the urinary tract of a 65-year-old man. The specimen, collected December 17, carried genes for three carbapenemases:
- New Delhi metallo-beta-lactamase (NDM);
- Verona integron-encoded metallo-beta-lactamase (VIM);
- OXA-48–type beta-lactamase.
It was resistant to 15 antibiotics tested — including amikacin, aztreonam, cefepime, ciprofloxacin, doxycycline, gentamicin, doripenem, ertapenem, imipenem, meropenem, levofloxacin, minocycline, piperacillin/tazobactam, tobramycin and trimethoprim/sulfamethoxazole — though colistin and tigecycline still worked against it in the lab. CDC recommends a public health response whenever emerging resistance such as metallo-beta-lactamases turns up.
Where it may have come from
| When | Care |
|---|---|
| Since September 2017 | Treatment at a local outpatient urology clinic (facility A) for urinary retention and an enlarged prostate, including cystoscopy, urinary catheter placement and a CT scan |
| November 1, 2018 | Outpatient urodynamic studies at a hospital in Punjab, India (facility B), with urinary and rectal catheters; no cystoscopy, no hospital stay |
| December 17, 2018 | Back home, a urinalysis at facility A showed signs of infection, and the urine culture grew the resistant bacterium |
His long-standing symptoms hadn't changed, so under standard guidelines he wasn't treated when the organism was found. Screening swabs on February 18, 2019, were negative.
The response
- The patient and family were taught how to prevent spread at home and told to share this history with future providers.
- Facility A flagged his record for contact precautions, to continue until rescreening 6 months after the positive culture.
- County and state health staff inspected facility A's infection control. CRE are reportable in Washington, and no other patients with matching strains were found there.
Lessons
- Look at outpatient clinics too. When emerging resistance appears, health departments should consider on-site infection control assessments in outpatient settings with higher transmission risk — those doing procedures on the digestive or urogenital tract or on wounds.
- Ask about medical care abroad. Providers should take a thorough history of care received outside the United States in the previous 6 months. Patients who stayed overnight in a hospital or had outpatient procedures abroad should be considered at risk of carrying CRE.
- Screen and test. Consider CRE screening for such patients before hospital admission or invasive procedures, and test their carbapenem-resistant isolates for carbapenemases. State health departments can request this testing through the Antibiotic Resistance Laboratory Network.
Sources
Based on Vannice K, Benoliel E, Kauber K, et al., "Notes from the Field: Clinical Klebsiella pneumoniae Isolate with Three Carbapenem Resistance Genes Associated with Urology Procedures — King County, Washington, 2018," Morbidity and Mortality Weekly Report 68(30), Centers for Disease Control and Prevention; a work of the United States government in the public domain. Original report.
Лицензия: CC0 1.0 (общественное достояние) · По материалам www.cdc.gov
1
0
0
0
Комментарии
