Colistin-Nonsusceptible Pseudomonas aeruginosa Sequence Type 654 with blaNDM-1 Arrives in North America.

This study describes 3 different blaNDM-1 genetic platforms in 3 different species obtained from the same patient who was directly transferred to an institution in Calgary, Alberta, Canada, following a prolonged hospital stay in India. The blaNDM-1 in the Escherichia coli isolate was located on a 176-kb IncA/C plasmid contained within an ISCR1 region. The blaNDM-1 in the Providencia rettgeri isolate was located on a 117-kb IncT plasmid contained within Tn3000, while the blaNDM-1 in the Pseudomonas aeruginosa isolate was located on the chromosome within an ISCR3 region. This report highlights the plasticity of the genetic regions and environments associated with blaNDM-1. To the best of our knowledge, this is the first report of P. aeruginosa with blaNDM-1 identified in North America and the first report of blaOXA-181 in P. rettgeri. The P. aeruginosa isolate belonged to the international high-risk sequence type 654 clone and was nonsusceptible to colistin. This case emphasizes the need for the use of appropriate infection prevention and control measures and vigilant screening for carbapenem-resistant Gram-negative bacteria in patients with a history of travel to areas of endemicity, such as the Indian subcontinent.

Treatment of infections caused by metallo-beta-lactamase-producing Pseudomonas aeruginosa in the Calgary Health Region.

This study reviewed 56 patients with significant metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa infections between May 2002 and March 2004 to identify features associated with mortality. Immunosuppression (p 0.002), bacteraemia (p 0.08) and inadequate antimicrobial therapy (p <0.001) were associated with death. Among those patients treated with adequate therapy, the use of multiple drug treatment regimens (two or three active agents) was associated with a non-significant two-fold increase in survival (p 0.45). Further prospective studies are warranted to determine the optimal treatment of MBL-producing P. aeruginosa infections.

Serotypes and antimicrobial susceptibility of Haemophilus influenzae.

During a one year prospective study of Haemophilus influenzae infections in patients treated in hospitals in the metropolitan area of Cape Town. H. influenzae type b accounted for 81.7% of 126 invasive isolates, whereas 86.1% of the 280 non-invasive isolates were non-typeable. Ampicillin resistance was detected among 10.8% of strains of which all but one produced beta-lactamase. All strains were susceptible to cefotaxime as were more than 95% to chloramphenicol, rifampicin, tetracycline but 20.4% were resistant to co-trimoxazole and 87.2% to erythromycin.

Epidemiology of invasive Haemophilus influenzae infections in Cape Town, South Africa.

The full spectrum of invasive Haemophilus influenzae disease has not been documented previously in Africa. This 1-year prospective study was designed to determine the epidemiology of invasive Haemophilus influenzae disease in Cape Town children. During this period, 142 children with invasive disease were hospitalized; 85 (59.9%) presented with meningitis, 35 (24.6%) with pneumonia and 22 (15.5%) with other diseases. No cases of epiglottitis were seen. Sixty per cent of cases were male and 40% female. The median age of the children was 9 months, with a range of 1-144 months, and 65.5% were aged < 12 months. Neurological dysfunction was noted in 40% and 18% of children with meningitis on admission and discharge, respectively. The overall case fatality rate (95% confidence intervals) was 9.2% (4.9-15.7), and for meningitis, pneumonia and septicaemia it was 4.7% (1.2-16.4), 14.3% (4.6-31.8) and 40% (8-78.1), respectively. Serotype b accounted for 86.5% of all cases, 97.3% of cases of meningitis, 71.4% of cases of pneumonia, 50% of cases of septicaemia, all cases of arthritis and cellulitis and none of mastoiditis. The incidence rates (95% confidence intervals) for all invasive type b infections were 169 (122-198) and 47 (39-57) per 100,000 population for children < 1 and < 5 years, respectively. For meningitis the rates were 112 (84-148) and 34 (25-40) per 100,000, respectively. Rates for mixed race and white children were similar, but those for black children were more than double those rates.(ABSTRACT TRUNCATED AT 250 WORDS)