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US patient dies from infection resistant to all antibiotics
drugs
‘Isolates that are resistant to all antimicrobials are very uncommon’.
Klebsiella pneumoniae was resistant to 26 drugs

A US patient has died after contracting an infection that was resistant to all available antibiotics, the Centers for Disease Control and Prevention (CDC) has revealed.

The female patient, who was in her 70s, was a resident of Washoe County in Reno, Nevada, but had recently returned from an extended trip to India.

She was admitted to an acute care hospital in the US in August 2016, with an initial diagnosis of systemic inflammatory response syndrome, most likely from an infected hip seroma, following an earlier right femur fracture and subsequent osteomyelitis of the femur and hip, for which she had been admitted to hospital in India on multiple occasions in the previous two years.

The patient was placed in a single room under contact precautions after testing identified carbapenem-resistant Enterobacteriaceae (CRE) - in this case Klebsiella pneumoniae - which was resistant to all available antimicrobial drugs. The patient went on to develop septic shock and died in September.

CDC confirmed the mechanism of antimicrobial resistance to be New Delhi metallo-beta-lactamase (NDM), an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics.

Testing revealed the isolate was resistant to 26 antibiotics, including all aminoglycosides and polymyxins that were tested, and intermediately resistant to tigecycline, which was developed in response to emerging antibiotic resistance.

According to a report on the case by CDC, ‘isolates that are resistant to all antimicrobials are very uncommon’.

Dr David Brown, chief scientist at Antibiotic Research UK, told BBC News: "It is still quite unusual for a bacterial infection to be resistant to such a large number of antibiotics. Fortunately it is an extreme case, but it may soon become all too common."

To slow the spread of bacteria with resistance mechanisms, such as NDM and MCR-1, CDC recommends that when these bacteria are identified, facilities use proper infection control contact precautions, and that health care contacts are evaluated for evidence of transmission.

Health care facilities should also obtain the patient’s history of exposure outside the region upon admission, and consider screening for CRE when patients report recent exposure outside of the US, or in regions of the US known to have higher rates of CRE.

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Vets to run marathon for World Animal Protection

News Story 1
 Two recently graduated veterinary surgeons will be running the London Marathon in April to raise money for the charity World Animal Protection.

Alex Bartlett and Maeve O'Neill plan to run the race together if they are given the same start times.

Dr O'Neill said: "You're always limited in what you can do to help animals, so it is nice to raise money for a charity that helps animals around the world."

Dr Bartlett added: "I have never run a marathon before and am excited to run my first one for such a good cause!"

Both Dr Bartlett and Dr O'Neill have fundraising pages online. 

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News Shorts
BSAVA releases new Guide to Procedures

The British Small Animal Veterinary Association (BSAVA) has published a new edition of its Guide to Procedures for Small Animal Practice.

It has added four new procedures; cystostomy tube placement, endotracheal intubation, point-of-care ultrasound and wet-to-dry dressings.

BSAVA says that it is an essential step-by-step guide to diagnostic and therapeutic procedures performed in practice. The textbook includes new images and illustrations, as well as high-definition videos for use prior to procedures.

Nick Bexfield and Julia Riggs, editors of the new edition, said: "We have built upon the success of the previous editions by responding to the feedback received from the BSAVA readership, and hope this new guide helps to further increase the confidence and accuracy with which these procedures are performed."

Print copies are available in the BSAVA store, with a digital version in the BSAVA library.