Thanks to Marc Sprenger of ECDC for retweeting the link this sobering report in NEJM: Preventing Lethal Hospital Outbreaks of Antibiotic-Resistant Bacteria. Excerpt:
In 2011, a strain of Klebsiella pneumoniae resistant to multiple antibiotics, including carbapenems, was identified in the intensive care unit (ICU) of the Clinical Center of the National Institutes of Health (NIH).1
This organism has since colonized at least 19 patients and may have caused seven deaths among patients with severe coexisting conditions. Although the spread of the organism was traced through clinical epidemiologic investigation and whole-genome sequencing, it was curtailed by “rigorous infection-control procedures.” What does this episode tell us about how to mitigate the risk of future outbreaks?
The threat of infections due to multidrug-resistant organisms (MDROs) is increasing. Methicillin-resistant Staphylococcus aureus (MRSA) has attracted the most attention, but multidrug-resistant gram-negative rods (MDR-GNRs) are more menacing. No effective drugs are available to treat some life-threatening MDR-GNR infections, and there are few new antimicrobials in development.
Resistance to cephalosporins is so widespread that many clinicians turn to carbapenems for serious infections, but as their use has increased, so has resistance. The problem is not confined to enteric gram negatives, as physicians faced with treating patients infected with acinetobacter, pseudomonas, and other pan-resistant strains are discovering.
Resistance that develops in one corner of the world can spread quickly, as demonstrated by MDR-GNRs containing New Delhi metallo-beta-lactamase 1.
In the NIH outbreak, molecular epidemiologic investigation provided insights into the spread and increasing antibiotic resistance of klebsiella. But the truth is that we already know how MDROs spread. Reliable adherence to basic infection control practices is the key to interrupting transmission in our hospitals.
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