384. Management of a New Delhi Metallo-beta-lactamase-1 enzyme (NDM-1)-Producing Klebsiella pneumoniae (KP): Infection Control and Medical Implications
Session: Poster Abstract Session: Gram Negative Infection - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • NDM-1 poster for IDSA 2011-10 V6.00.pdf (1.2 MB)
  • Background: Enterobacteriaceae carrying NDM-1 are rare in North America and are associated with medical care in South Asia.  An US national, hospitalized in India, was transferred to our community hospital.  A tracheostomy aspirate obtained from the patient while febrile grew an NDM-1 producing KP and pan-resistant strains of Acinetobacter sp and Pseudomonas aeruginosa.  We present the management and infection prevention issues associated with this patient.

    Methods: The patient was placed in a private room on contact isolation, with 1:1 nursing. Staff was educated. To determine if nosocomial transmission or environmental contamination occurred, peri-rectal areas and wounds were cultured on all patients in proximity to the index patient (point prevalence). Tracheostomy aspirates were obtained from patients throughout the hospital who shared the index patient's respiratory therapists. Serial environmental cultures were obtained from his room. Peri-rectal, wound, stool, urine and tracheal cultures were obtained from the patient to determine duration of colonization. Patient care areas were cleaned and disinfected with vaporized hydrogen peroxide.

    Results: 24 rectal swabs, 6 tracheal aspirates, and 2 wound cultures were obtained on 24 patients. A total of 35 environmental swabs were obtained. None of these cultures grew  NDM-1 producing organisms. 14 surveillance cultures were obtained from the index case.  The patient was intermittently colonized with the NDM-1 KP from stool and tracheal aspirates for > 4 months.  Interestingly, surveillance cultures revealed an NDM-1 Salmonella Senftenberg from a rectal swab. The patient received rifaximin for 12 days and the 1st post-decolonization stool culture did not grow Salmonella.

    Conclusion: NDM-1 producing Enterobacteriaceae are of great clinical concern because of limited treatment options. Restricting the spread of the NDM-1 in healthcare facilities in the US is critical. We found that management consisting of rapid identification of a patient with the relevant epidemiological risk factors, education for the staff, immediate contact isolation in a private room, 1:1 nursing care and aggressive cleaning and disinfection, limited the environmental burden and prevented transmission of this organism.


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Ramya Gopinath, MD FRCP (C)1, Patrice Savard, MD MSc FRCP(C)2, B. Mark Landrum, MD3, Barbara O'Connor, RN4, Lucy Wilson, MD, ScM5, Karen Carroll, MD, FIDSA6 and Trish Perl, MD, MSc, FIDSA2, (1)Infectious Disease/Hospital Epidemiology and Infection Control, Howard County General Hospital, Columbia, MD, (2)Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD, (3)Infectious Disease/Infection Control, Howard County General Hospital, Columbia, MD, (4)Hospital Epidemiology and Infection Control, Howard County General Hospital, Columbia, MD, (5)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (6)Pathology, Johns Hopkins University School of Medicine, Baltimore, MD

    Disclosures:

    R. Gopinath, None

    P. Savard, None

    B. M. Landrum, None

    B. O'Connor, None

    L. Wilson, None

    K. Carroll, Quidel, Inc.: Consultant, Consulting fee
    NanoMR: Consultant, Consulting fee
    BD Diagnostics, Inc: Research Contractor, Research support

    T. Perl, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.