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Int J Infect Dis. 2015 Jan;30:20-6. doi: 10.1016/j.ijid.2014.09.010. Epub 2014 Oct 30.

Sepsis caused by New Delhi metallo-β-lactamase (blaNDM-1) and qnrD-producing Morganella morganii, treated successfully with fosfomycin and meropenem: case report and literature review.

Author information

1
Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
2
Cátedra de Enfermedades Infecciosas, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
3
Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay.
4
Centro de Nefrología Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
5
Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay. Electronic address: rvignoli@higiene.edu.uy.

Abstract

OBJECTIVES:

The objective of this study was to describe the microbiological characteristics of an extensively drug-resistant (XDR) isolate of Morganella morganii obtained from a patient with sepsis of urinary origin and to describe the patient's clinical characteristics. We further aimed to perform a literature review of the situation in Latin America regarding Gram-negative bacillus (GNB) carriers of New Delhi metallo-β-lactamase (NDM-1) and qnr genes and current reports on the treatment of infections caused by XDR enterobacteria, with particular attention to colistin-resistant isolates.

METHODS:

The patient's clinical data were obtained from his medical history. Microbiological identification and susceptibility testing were done using the VITEK 2 Compact System. Resistance genes were detected by PCR and sequencing.

RESULTS:

Blood and urine cultures grew an M. morganii isolate (Mm4232) harboring NDM-1 and qnrD1. The patient was treated successfully with fosfomycin and double doses of meropenem. There are no previous reports of the use of fosfomycin and meropenem to treat infections by XDR enterobacteria harboring NDM-1 carbapenemase.

CONCLUSIONS:

This is the first report of qnrD1 in South America. We consider that this report could be helpful to physicians implementing treatments for infections caused by XDR GNB, including colistin-carbapenem-resistant GNB.

KEYWORDS:

Fosfomycin; Meropenem; Morganella morganii; NDM-1; Sepsis

PMID:
25447717
DOI:
10.1016/j.ijid.2014.09.010
[Indexed for MEDLINE]
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