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Genetic analysis suggested the isolates were unique to the NIH Clinical Center.
The study dashes hopes that combining piperacillin and tazobactam might help prevent overuse of carbapenems.
Researchers say better communication about antibiotics is needed, and dentists need to be included in stewardship programs.
Removing sinks and using a "water-free" method of care reduced colonization with gram-negative bacilli.
Poorly maintained water systems are typically to blame, and those in long-term care facilities are especially vulnerable.
Data showed an interesting ebb and flow, as well as evidence of slowly increasing bacterial resistance.
Though the CDC reported good progress earlier this year, central-line infections remain a key problem.
The WHO's update on 13 cases reported from Saudi Arabia also includes a pair of household contacts and some cases with camel exposure.
The bacterium may have recently evolved to spread person to person, as it becomes more virulent.
The WHO says preventive antibiotics should be used before and during surgery but not after.
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