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J Hosp Infect. 2016 Dec;94(4):351-357. doi: 10.1016/j.jhin.2016.08.005. Epub 2016 Aug 19.

An Irish outbreak of New Delhi metallo-β-lactamase (NDM)-1 carbapenemase-producing Enterobacteriaceae: increasing but unrecognized prevalence.

Author information

1
Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
2
School of Medicine National University of Ireland Galway, Galway, Ireland; Carbapenemase-Producing Enterobacteriaceae (CPE) Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland.
3
Carbapenemase-Producing Enterobacteriaceae (CPE) Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland.
4
Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland.
5
Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
6
Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.
7
Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland. Electronic address: colum.dunne@ul.ie.

Abstract

BACKGROUND:

Carbapenemase-producing Enterobacteriaceae (CPE) may cause healthcare-associated infections with high mortality rates. New Delhi metallo-β-lactamase-1 (NDM-1) is among the most recently discovered carbapenemases.

AIM:

To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures.

METHODS:

This was a retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE-positive culture. Contacts were designated as roommates or ward mates.

FINDINGS:

This outbreak involved 10 patients with a median age of 71 years (range: 45-90), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonized. Nine NDM-1-producing Klebsiella pneumoniae, an NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24, 2014 and week 37, 2014. Pulsed-field gel electrophoresis demonstrated similarity. NDM-1-positive isolates were meropenem resistant with minimum inhibitory concentrations (MICs) ranging from 12 to 32 μg/mL. All were tigecycline susceptible (MICs ≤1 μg/mL). One isolate was colistin resistant (MIC 4.0 μg/mL; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected.

CONCLUSION:

The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but several had frequent hospitalizations in Ireland, raising concerns regarding the possibility of increasing but unrecognized prevalence of NDM-1 and potential decline in value of travel history as a marker of colonization risk.

KEYWORDS:

Carbapenemase-producing Enterobacteriaceae; Ireland; Multidrug-resistant organism; New Delhi metallo-β-lactamase-1 (NDM-1); Outbreak

PMID:
27624807
DOI:
10.1016/j.jhin.2016.08.005
[Indexed for MEDLINE]

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