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