title: Gram-negative bacteria that produce carbapenemases causing death attributed to recent foreign hospitalization.
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.
authors.affiliation: University of Alberta, Calgary, Alberta, Canada.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Ahmed-Bentley
authors.forename: A Uma
authors.initials: AU
authors.lastname: Chandran
authors.forename: A Mark
authors.initials: AM
authors.lastname: Joffe
authors.forename: Desiree
authors.initials: D
authors.lastname: French
authors.forename: Gisele
authors.initials: G
authors.lastname: Peirano
authors.forename: Johann D D
authors.initials: JD
authors.lastname: Pitout
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins / Q000378:metabolism*; D003428:Cross Infection / Q000382:microbiology; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification / Q000378:metabolism; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification / Q000378:metabolism; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058889:Molecular Typing; D058885:Multilocus Sequence Typing; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C466679:beta-lactamase OXA-23; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1; C063912:carbapenemase