Stewardship / Resistance Scan for Jul 11, 2017

Candida auris in Canada
MCR-1 in Vietnamese hospital

Canada reports first case of Candida auris

Canadian researchers are reporting the first case of the drug-resistant fungal pathogen Candida auris in Canada.

In a case study in Canada Communicable Disease Report, the researchers report that the patient, a 64-year-old individual with a 2-year history of ear complaints, was treated for chronic otitis externa shortly after admission to a tertiary hospital for management of a brain abscess. Previous medical history included a recent hospitalization in India for elective oral surgery. During outpatient follow-up, swabs of the patient's ear discharge revealed the presence of C auris that was resistant to fluconazole and amphotericin B and likely resistant to voriconazole. Case resolution was pending at the time of the report.

The authors of the report say the origin of the infection is unknown but suggest it could be connected to the patient's hospitalization in India, where C auris is endemic.

C auris was originally discovered in 2009 in Japan and since then has emerged as a global health threat owing to its growing resistance to all three major classes of antifungals used to treat Candida infections and its ability to persist on patients and in hospital environments. The US Centers for Disease Control and Prevention (CDC) estimates the mortality rate of C auris infections at approximately 60%. Optimal management for C auris infections is currently unknown.

To help curb the spread of the fungus, the CDC recommends using standard and contact precautions for infected and colonized patients, housing patients in private rooms, cleaning patient rooms daily with a disinfectant active against Clostridium difficile, and informing healthcare facilities when an infected or colonized patient is being transferred in. In the current case, contact precautions had already begun after routine screening had indicated the patient was a carrier of carbapenem-resistant Enterobacteriaceae.

The authors say that since several C auris cases in the United States have been linked to hospitalization abroad, contact precautions and testing may be indicated for anyone who's been hospitalized outside Canada. "This approach may help contain C. auris from nosocomial transmission within and between Canadian healthcare facilities," they write.
Jul 6 Can Commun Dis Rep rapid communication


Study identifies hospital-acquired, MCR-1-carrying isolates in Vietnam

Two colistin-resistant Escherichia coli isolates harboring the MCR-1 gene have been identified in medical settings in Vietnam, researchers reported yesterday in the International Journal of Infectious Diseases.

The two E coli isolates—strains NCGM-EC88 and NCGM-E89—were identified among a total of 18 multidrug-resistant E coli isolates obtained through routine screening for multidrug-resistant pathogens at a Vietnamese hospital in 2014; they were isolated from pus and urine samples from two inpatients.

Susceptibility testing showed that both isolates were resistant to ciprofloxacin and colistin but susceptible to carbapenems, while genomic sequencing revealed that the MCR-1 gene was located on the chromosomes of both isolates. Both isolates also contained a single copy of an insertion element, ISAp11, which can contribute to the insertion of MCR-1 from bacterial plasmids into chromosomes.

Multilocus sequence typing revealed that the two E coli isolates belonged to sequence type (ST) 410 and ST457, both of which have been isolated from food and pet animals in several countries.

Since MCR-1 was first identified in E coli samples from pigs, pork products, and humans in China in November 2015, the colisitin-resistance gene has been identified in bacteria from humans, animals, and the environment in more than 30 countries, and studies have documented the spread of the gene to the clinical setting in China. The authors of the study say they believe this is the first report of hospital-acquired E coli isolates harboring MCR-1 in a medical setting in Vietnam.
Jul 10 Int J Infect Dis abstract

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