Stewardship / Resistance Scan for Jan 10, 2019

MCR-1 in Wyoming
CDC alert over Mexico infections

Wyoming reports colistin-resistant MCR-1 infection

A patient in a Laramie County, Wyo., hospital has been confirmed to have an infection caused by an Enterobacteriaceae containing the MCR-1 resistance gene, which confers resistance to the critical antibiotic colistin, the Wyoming Department of Health (WDH) said yesterday in a news release.

The patient is receiving care at Cheyenne Regional Medical Center (CRMC), but officials say the infection was likely acquired outside the hospital. Hoo Feng Choo, MD, an infectious disease specialist at CRMC, said "Thankfully, the patient continues to receive care, has responded to treatment, and is in good condition."

Tests by a US Centers for Disease Control and Prevention (CDC) lab confirmed the findings.

Alexia Harrist, MD, PhD, state health officer, said, "When bacteria become antibiotic-resistant, then certain categories of antibiotic medicines will not work to kill the bacteria to treat an infection. In this case, the organism found is resistant to a category of antibiotics sometimes described as 'last resort' medications used to fight infections. The gene found with this patient has been identified in only a handful of states over the past few years."

She added, "We believe the contact precautions already in place at the hospital have likely limited the potential spread of the bacteria." WDH epidemiologist are working with CRMC staff to help with infection control.

MCR-1 was first identified in China in 2015 and has since been reported in more than 30 nations.
Jan 9 WDH news release


CDC issues advisory over antibiotic-resistant infections in Tijuana, Mexico

The CDC yesterday warned the public and healthcare professionals about potential infections with an antibiotic-resistant form of Pseudomonas aeruginosa bacteria after US residents contracted the serious infections following medical procedures in Tijuana, Mexico.

The agency issued a level 2 (out of 3) alert and recommended visitors to practice enhanced precautions. "All of the travelers with this particular infection had an invasive medical procedure performed in Tijuana," the CDC said. "Most (but not all) of them had weight-loss surgery. About half of those infected had their surgery done at the Grand View Hospital."

Mexican officials have closed the hospital until further notice, the CDC said. It did not specify the number of cases but said, "Infections caused by this particular drug-resistant Pseudomonas are rare in the United States and difficult to treat."

The advisory includes several steps travelers should take, including seeing a travel medicine specialist at least a month before their trip, as well as recommendations for clinicians. Pseudomonas is found widely in the environment, and P aeruginosa is the most common type that infects people.
Jan 9 CDC alert

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