Ndm1 information newsletter.cdr

EXCEED EXPECTATIONS: “Pathology that Adds Value”
Emergence of carbapenem resistant Enterobacteriaceae in South Africa
Introduction
Treatment
A recent article in the Lancet highlighted the emergence of Many NDM-1 producers remain susceptible only to colistin and Enterobacteriaceae with resistance to carbapenems, conferred by tigecycline. A few isolates, mostly E. coli, retain a degree of New Delhi metallo-β-lactamase 1 (NDM-1). NDM-1 refers to a susceptibility to antibiotics such as chloramphenicol, tetracycline, transmissible genetic element encoding multiple resistance genes fosfomycin, aminoglycosides and aztreonam. Combination that was initially isolated from a strain of Klebsiella obtained from a therapy is associated with improved outcome.
patient who acquired the organism in New Delhi, India.
Early identification of cases of NDM-1-related infections and of the The authors identified numerous isolates with NDM-1 in India, carriers is essential. NDM-1 susceptibility to carbapenems varies Pakistan and the UK. Except for central and South America this and ertapenem may be the most appropriate for detecting NDM-1 mechanism of resistance has now been identified worldwide. NDM-1 was mostly found among Escherichia coli and Klebsiella producers with low-level resistance to this group of antimicrobials.
pneumoniae, which were highly resistant to all antibiotics except to Laboratory diagnosis
tigecycline and colistin. These organisms also carry numerous other antibiotic resistance genes including those mediating Phenotypic identification is difficult and molecular-based resistance to aminoglycosides, macrolides, sulphamethoxazole, techniques such as PCR are the gold standard for identification of quinolones and other beta-lactams. Accordingly, most strains NDM-1 producers. PathCare will automatically screen all present with a multi-drug resistant (MDR) phenotype and some Enterobacteriaceae resistant to any of the carbapenems, for the may even present with a pan-drug resistant (PDR) phenotype. This mechanism of resistance has now also been confirmed in Infection control and screening
South Africa and will present a significant therapeutic challenge to Isolation precautions should be applied for all patients colonized or infected with a NDM-1 organism. These patients should also be Risk factors
cohorted and preferably treated by dedicated staff. Active screening policies might have to be implemented via stool or The type of infections associated with NDM-1 producers are mostly rectal swab cultures. Current guidelines suggest screening of hospital-acquired infections, however, indirect fecal-oral patients who received medical care in India or Pakistan during the transmission may be likely to play a major role in community last 6 months, but prolonged hospitalization, patients who are settings, via contaminated hands, food and water.
critically ill and exposed to invasive devices (e.g., ventilators or central venous catheters) are also at risk and might have to be Previous antimicrobial exposure, prolonged hospitalization, included in screening procedures to detect NDM-1. presence of invasive devices, and immunosuppression are all Hospitals should also perform active surveillance cultures of associated with the selection of NDM-1 resistance.
patients with epidemiologic links to persons from whom Infections associated with NDM-1
carbapenem resistant Enterobacteriaceae have been recovered. In such instances, infection prevention measures should be Isolates of Enterobacteriaceae producing NDM-1 have caused a vigorously reinforced, and surveillance cultures repeated weekly range of infections, most commonly urinary tract infections, but also septicaemia, pulmonary infections, peritonitis, soft tissue infections LABORATORY UPDATE
www.pathcare.co.za
November 2011
atologie wat Waarde Toevoeg”
Verskyning van karbapenem-weerstandige Enterobacteriaceae in Suid-Afrika
Inleiding
Behandeling
'n Onlangse artikel in die Lancet vestig aandag op die verskyning Talle NDM-1-produseerders bly vatbaar net vir kolistien en van Enterobacteriaceae met weerstand teen karbapenems, tigesiklien. Enkele isolate, veral E.coli, behou 'n mate van verleen deur die Nieu-Delhi metallo-β-laktamase 1 (NDM-1). gevoeligheid vir antibiotika soos chlooramfenikol, tetrasiklien, NDM-1 verwys na 'n oordraagbare genetiese element wat vir fosfomisien, aminoglikosiede en aztreonam. Kombinasieterapie veelvuldige weerstandgenes kodeer en wat aanvanklik vanaf 'n stam van Klebsiella van 'n pasiënt wat die organisme in Nieu-Delhi, Vroeë identifikasie van NDM-1-verwante infeksies en van draers is noodsaaklik. NDM-1-vatbaarheid vir karbapenems varieer en Die skrywers het talle isolate met NDM-1 in Indië, Pakistan en die ertapenem is moontlik die mees toepaslike vir die opsporing van VK geïsoleer. Met die uitsondering van Sentraal- en Suid-Amerika NDM-1-produseerders met laevlak weerstand teenoor hierdie is hierdie meganisme van weerstand reeds wêreldwyd geïdentifiseer. NDM-1 is meestal in Eschericia coli en Klebsiella pneumoniae gevind wat hoogs weerstandig teenoor alle Laboratoriumdiagnose
antibiotika, met die uitsondering van tigesiklien en kolistien, was. Identifikasie van fenotipe is moeilik en molekulêre tegnieke soos Hierdie organisme dra ook vele ander weerstandsgenes teenoor PKR is die goue standaard vir identifikasie van NDM-1- antibiotika, insluitende dié wat weerstand teen aminoglikosiede, produseerders. PathCare sal outomaties alle Enterobacteriaceae makroliede, sulfametoksasool, kinoliene en ander beta-laktame weerstandig teen enige van die karbapenems vir NDM-1 sif.
kodeer. Ooreenstemmend doen die stamme voor met 'n multi- middelweerstandige (MDR) fenotipe en sommige mag selfs met 'n Infeksiebeheer en sifting
panweerstandige (PDR) fenotipe voordoen. Voorkomende isolering van alle gekoloniseerde of geïnfekteerde Hierdie meganisme van weerstand is nou ook in Suid-Afrika pasiënte met 'n NDM-1-organisme behoort plaas te vind. Hierdie bevestig en sal 'n betekenisvolle terapeutiese uitdaging aan klinici pasiënte behoort ook saam en verkieslik deur toegewyde personeel behandel te word. Dit mag nodig wees om aktiewe sifting via stoelgang- en rektale depper-kwekings te implimenteer. Risikofaktore
Huidige riglyne stel sifting voor van pasiënte wat mediese sorg in Die soort infeksies wat met NDM-1-produseerders geassosieer Indië of Pakistan gedurende die voorafgaande 6 maande ontvang word is meesal hospitaalverworwe infeksies, hoewel indirekte het, maar verlengde hospitalisering, kritieke siek en pasiënte aan fekale tot mondoordrag moontlik 'n belangrike rol in die indringende toestelle blootgestel (bv. ventilators of sentrale gemeenskapsomgewing via besmette hande, kos en water mag veneuse kateters) is ook onderhewig aan risiko en mag moontlik by siftingsprodures om NDM-1 op te spoor, ingesluit word.
Vorige antimikrobiese blootstelling, verlengde hospitalisering, Hospitale behoort ook aktiewe oorsigskwekings van pasiënte te inblywende toestelle, en immuun- onderdrukking hou almal met die doen wat epidemiologiese kontak gehad het met persone van wie seleksie van NDM-1-weerstand verband.
karbapenem-weerstandige Enterobacteriaceae geïsoleer is. In sulke gevalle moet infeksievoorkomende maatreëls energiek Infeksies met NDM-1 geassosieer
toegepas word, en oorsigskwekings weekliks gedoen word totdat geen nuwe gevalle meer opgespoor word nie.
Isolate van Enterobacteriaceae wat NDM-1 produseer veroorsaak 'n verskeidenheid infeksies waarvan urineweginfeksies die mees algemeen is, maar ook septisemie, longinfeksies, perotinitis, sagte weefselinfeksies en toestelgeassosieerde infeksies word gesien.
LABORATORIUM OPKNAPPER
www.pathcare.co.za
November 2011

Source: http://www.pathcare.co.za/webfiles/files/NDM1Informationnewsletter.pdf