title: Multidrug-Resistant Tuberculosis Complicated by Nosocomial Infection with Multidrug-Resistant Enterobacteriaceae.
abstract: Treatment of mycobacterial diseases such as tuberculosis (TB) entails long and intense antimicrobial therapy. TB patients are at risk of coinfection with other multidrug-resistant bacteria, such as those from Enterobacteriaceae family, because of antimicrobial selection pressure and nosocomial transmission during prolonged hospital admission. Here, we report on two patients treated for multidrug-resistant TB, who developed severe sepsis due to an extended spectrum β-lactamase producing organism. Diagnostic culture identified the venous access port as source, and upon surgical removal and antimicrobial therapy rapid clinical improvement was achieved. Increased awareness and knowledge on the prevalence of multi-resistant Enterobacteriaceae is needed, notably in TB centers, to provide a safe hospital environment to our patients.
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands m.i.p.groschel@umcg.nl.
authors.forename: Matthias I
authors.initials: MI
authors.lastname: Gröschel
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Till F
authors.initials: TF
authors.lastname: Omansen
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Wiel
authors.initials: W
authors.lastname: de Lange
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Tjip S
authors.initials: TS
authors.lastname: van der Werf
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Mariëtte
authors.initials: M
authors.lastname: Lokate
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Bathoorn
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Onno W
authors.initials: OW
authors.lastname: Akkerman
authors.affiliation: Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Ymkje
authors.initials: Y
authors.lastname: Stienstra
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003428:Cross Infection; D004755:Enterobacteriaceae; D004756:Enterobacteriaceae Infections / Q000209:etiology* / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents