#2 Bacteria That Killed Nevada Patient Resisted All Antimicrobial Drugs Currently Available
The Centers for Disease Control and Prevention (CDC) have confirmed that the death of a Nevada woman that occurred this past September was due to Klebsiella pneumoniae, a carbapenem-resistant Enterobacteriaceae (CRE) that resisted a total of 26 different antimicrobial drugs – all that are currently available for use on this type of infection in the United States. Due to the patient’s recent return from India and previous hospitalization in that country, the Washoe County Health District acute care hospital placed her in a single room under “contact precautions,” meaning that healthcare workers were instructed to wear personal protective equipment while in the room with the patient and that the hospital took particular care with either sterilizing or disposing of medical instruments and devices as well as frequently cleaning and disinfecting the room itself. After the patient was hospitalized, the CDC tested an isolate collected from a wound specimen and confirmed that she had been infected by a pan-resistant bacterium, New Delhi metallo-beta-lactamose (NDM).
The patient had recently returned to the United States after an extended visit to India, where she had been hospitalized repeatedly for a right femur fracture and subsequent complications related to that injury and its treatment. She had been hospitalized in India as recently as June 2016. When she was admitted to acute care in Reno, Nevada, in August 2016, she was given a primary diagnosis of systemic inflammatory response syndrome. She developed septic shock and died in early September 2016 after failing to respond to 26 different antibiotic regimens, including all aminoglycosides and polymyxins. The infection was “intermediately resistant to tigecycline,” the CDC noted. Although CDC testing indicated that the isolate had relatively low fosfomycin MIC of 16 μg/mL, the patient did not receive this treatment as it is only approved in oral form to treat uncomplicated cystitis in the United States. In other countries, it can be administered intravenously.
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