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Carbapenem-resistant enterobacteriacae: a challenge for early detection and infection control

Introduction / objectives

In 2009, in response to the threat of emerging carbapenem-resistant Enterobacteriaceae, an alert system was introduced at Geneva University Hospitals.

Methods

The alert system detected patients harboring carbapenemase-producing strains as KPC or non-KPC. Referrals from other hospitals were screened on admission for the presence of multiresistant organisms, and put under contact control precautions if positive.

Results

Between October 2009 - January 2010, we identified 1 imported case of KPC (origin, Southern Italy) and 3 cases of NDM-1 producing Enterobacteriaceae, transferred from hospitals in India (1), Pakistan (2) and Serbia/France(3).

Patient 1- on admission digestive carrier of E. coli blaNDM-1.

Patient 2- digestive carrier of P. mirabilis blaNDM-1 detected after extended hospitalization and antibiotic therapy

Patient 3- hospitalized in Serbia and France, with K. pneumonia blaNDM-1 urinary tract infection on admission.

All 3 patients were carriers of other multiresistant, Gram-negative bacteria on admission. The NDM-1 molecular identification was made retrospectively in October 2010. Patient 4 was admitted for elective surgery, without prior history of hospitalization. A urine culture yielded K. pneumonia blaKPC-2. The patient was put under strict contact precautions; but developed a surgical site infection with treatment challenges related to dose finding, availability, toxicity of antibiotics. No secondary cases were found due to early screening and preemptive isolation.

Conclusion

The threat of carbapenemase-producing strains underlines the need for early detection, implementation of control measures and surveillance, which needs constant updating. The laboratory alert system focused on KPC but ignored initially the NDM-1 threat.

Disclosure of interest

None declared.

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Correspondence to C Fankhauser.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fankhauser, C., Cherkaoui, A., Renzi, G. et al. Carbapenem-resistant enterobacteriacae: a challenge for early detection and infection control. BMC Proc 5, P142 (2011). https://doi.org/10.1186/1753-6561-5-S6-P142

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Keywords

  • Pneumonia
  • Urinary Tract Infection
  • Urine Culture
  • Early Screening
  • Secondary Case