Two for the price of one: emerging carbapenemases in a returning traveller to New York City.
Two for the price of one: emerging carbapenemases in a returning traveller to New York City.
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DOI：
10.1136/bcr-2018-225440
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发表时间：
2018-07-18
期刊：
影响因子：
0.9
通讯作者：
Nori, Priya
中科院分区：
文献类型：
--
作者：
Mittal, Jaimie;Szymczak, Wendy A;Nori, Priya
我们报告一例复杂的骨科感染的病人返回纽约市从孟加拉国，他在那里参与了严重的机动车事故。该分离株是独特的，因为同时存在新德里金属β-内酰胺酶-1和苯唑西林酶181型碳青霉烯酶，这在北美相对罕见，可能是在孟加拉国获得的。在此，我们探讨了与碳青霉烯类耐药肠杆菌科感染管理相关的挑战，包括有效抗菌治疗的有限可用数据。我们还强调了快速诊断技术在指导临床管理方面的附加值。最终，患者需要积极的手术治疗和氨曲南和头孢他啶-阿维巴坦联合治疗，以实现真正的源控制和良好的临床结局。
We report a case of a complex orthopaedic infection in a patient returning to New York City from Bangladesh where he was involved in a serious motor vehicle accident. He developed extensive osteomyelitis with a carbapenem-resistant Klebsiella pneumoniae The isolate was unique due to the coexistence of New Delhi metallo-beta-lactamase-1 and Oxacillinase type-181 carbapenemases, which are relatively uncommon in North America and were presumably acquired in Bangladesh. Herein, we explore challenges associated with management of carbapenem-resistant Enterobacteriaceae infections, including limited available data on effective antimicrobial therapy. We also highlight the added value of rapid diagnostic technology in guiding clinical management. Ultimately, the patient required both aggressive surgical management and combination therapy with aztreonam and ceftazidime-avibactam for true source control and favourable clinical outcome.