NEW DELHI METALLOBETALACTAMASE CARRYING BACILLI - CANADA: (ALBERTA) NOSOCOMIAL, FATAL

Date: Fri 18 May 2012
Health officials suspect a Royal Alexandra Hospital patient died after picking up antibiotic-resistant bacteria brought to Edmonton by an infected traveller. After the infection was discovered, Alberta Health Services closed various Royal Alex wards to new patients, screened more than 300 patients who might have been exposed and identified 7 with confirmed or suspected antibiotic-resistant bacteria.
Dr. Mark Joffe, senior medical director in charge of infection, prevention and control for the provincial health authority, said he suspects there is a link between the unidentified patient who died and a woman who travelled to the Indian subcontinent, where she was injured and required surgery. 5-6 weeks after her return to Edmonton, she went to the Royal Alex with an infection at the surgical site. She was not immediately isolated, as is the protocol, but spent about 3 days receiving treatment before it was determined she had 2 types of bacteria.

 One, called _Acinetobacter_, has occasionally infected Albertans before. The other bacterium carries genes [producing] New Delhi metallo-beta-lactamase, or NDM, which [confer resistance] to multiple antibiotics. Alberta has had only one confirmed case about one year ago. The female patient at the Royal Alexandra had 2 different strains of NDM. Following that discovery, various hospital units were closed to additional admissions — one remains so — and more than 300 patients from 5 units were tested for various antibiotic-resistant bacteria; 2 people were confirmed to have _Acinetobacter_ and 2 more have the bacteria that contain NDM. 2 others, including the patient who died in the last 10 days after an infection post-surgery, are still being investigated to determine whether they are linked to the spread in the hospital. “We suspect. We’re concerned. We are investigating further,” Joffe said.

 He said test results should be complete by next week. He said Alberta Health Services is also investigating why the female traveller wasn’t immediately isolated when she arrived for emergency care at the Royal Alex, since that is the health authority’s protocol for sick global travellers.
 The bacteria likely travelled between patients on unwashed hands of nurses, doctors, aides or anyone else with direct patient contact, Joffe said. “I can tell you that they washed their hands most of the time, maybe almost all the time, but I suspect there was at least one opportunity for cleaning their hands that must have been missed,” Joffe said, noting there are initiatives underway to encourage and track hand-washing before and after patient care

. Of the 7 patients with the suspected bacteria, 3 remain isolated in hospital and will remain so until the bacterium clears itself out, which can take weeks or months. 5 — all except the female traveller and the patient who died — are carriers of the bacteria and haven’t become ill or infected from it. “In general, it’s not dangerous,” Joffe said.
 But people who have compromised immune systems, who have had surgery and have catheters or intravenous lines put in, are more at risk. If the bacterium enters their bodies, many types of antibiotics won’t work to clear the infection. Our hope is that we have contained these strains for now and, hopefully, indefinitely. But the reality is these bacteria are global travellers,” Joffe said. “This won’t be the last time we’ll see this. … This is a reality of modern health care. This is something we can’t escape from and something we need to be very vigilant about.”

He said patients and visitors to hospitals can help by washing their hands and asking health-care workers if they’ve washed their hands and stethoscopes. “Cleaning of hands is the simplest single most important measure for preventing the spread of bacteria,” Joffe said. “Antibiotics are a precious resource and we all need to use antibiotics responsibly.” He said Albertans shouldn’t be scared. “There is no such thing as zero risk,” he said of hospital care. But he said, “We’ve been extremely aggressive in our approach to controlling these bacteria. We are confident that it is now controlled. … We work very hard every day to make sure health care is as safe as it possibly can be.” The investigation to determine why the initial patient wasn’t isolated upon admission is expected to take several weeks.

http://www.edmontonjournal.com/health/Health%20officials%20closer%20to%20determining%20source%20of%20antibiotic-resistant%20bacteria%20that%20killed%20patient/6645859/story.html