In northern NSW, we already face cases similar to that described below – infection with multi-drug resistant carbapenemase-producing Gram negative organisms. The major global types of these organisms are named with acronyms that refer to the type of carbapenemase gene – KPC, NDM (New Delhi Metallobetalactamase), IMP (imipenemase) and others. KPC-type organisms are prevalent in Greece, Spain, Israel and Eastern USA. NDM type predominate in SE Asia, India and Nepal. Organisms of the IMP-4 type occur sporadically within healthcare facilities along the Eastern seaboard of Australia.
Pathology North tests significant coliform isolates (E. coli, Klebsiella and the like) for ceftriaxone or meropenem resistance and submits these for genotypic detection of ESBL and carbapenemase genes. See here for a recent local MRGN epidemiology report. Useful guide to terminology and carbapenem resistant organisms.
Australia published national guidelines for control of Carbapenem-resistant Enterobacteriaceae (CRE) in 2012 and an update process for these has just begun.
Case report (full case report with expert commentary is free)
Carbapenem-resistant Enterobacteriaceae (CRE) usually infect patients with significant co-morbidities and health care exposures. We present a case of a pregnant woman who developed community-acquired pyelonephritis caused by KPC-producing Klebsiella pneumoniae. Despite antibiotic treatment, she experienced spontaneous prolonged rupture of membranes, with eventual delivery of a healthy infant. This report demonstrates the challenge that CRE may pose to the effective treatment of common infections in obstetric patients, with potentially harmful consequences to maternal and neonatal health.
This is a new Antimicrobial Agents and Chemotherapy Journal section that presents a real, challenging case involving a multidrug-resistant organism. The case authors present the rationale for their therapeutic strategy and discuss the impact of mechanisms of resistance on clinical outcome. An expert clinician then provides a commentary on the case.