US patient dies from infection resistant to all antibiotics
‘Isolates that are resistant to all antimicrobials are very uncommon’.
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.
RCVS Knowledge has welcomed Professor Peter Cockcroft as editor-in-chief for Veterinary Evidence. 
