Two for the price of one: Emerging carbapenemases in a returning traveller to New York City

Jaimie Mittal, Wendy A. Szymczak, Yi Guo, Michael H. Levi, Liang Chen, Barry N. Kreiswirth, Paul F. Riska, Priya Nori

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We report a case of a complex orthopaedic infection in a patient returning to New York City from Bangladesh where he was involved in a serious motor vehicle accident. He developed extensive osteomyelitis with a carbapenem-resistant Klebsiella pneumoniae. The isolate was unique due to the coexistence of New Delhi metallo-β-lactamase-1 and Oxacillinase type-181 carbapenemases, which are relatively uncommon in North America and were presumably acquired in Bangladesh. Herein, we explore challenges associated with management of carbapenem-resistant Enterobacteriaceae infections, including limited available data on effective antimicrobial therapy. We also highlight the added value of rapid diagnostic technology in guiding clinical management. Ultimately, the patient required both aggressive surgical management and combination therapy with aztreonam and ceftazidime-avibactam for true source control and favourable clinical outcome.

Original languageEnglish (US)
Article numberbcr-2018-225440
JournalBMJ Case Reports
Volume2018
DOIs
StatePublished - Jan 1 2018

Fingerprint

Carbapenems
Bangladesh
Enterobacteriaceae Infections
Aztreonam
Klebsiella pneumoniae
Motor Vehicles
Osteomyelitis
North America
Accidents
Orthopedics
Technology
Therapeutics
Infection
ceftazidime drug combination avibactam
oxacillinase

Keywords

  • bone and joint infections
  • infections

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Two for the price of one : Emerging carbapenemases in a returning traveller to New York City. / Mittal, Jaimie; Szymczak, Wendy A.; Guo, Yi; Levi, Michael H.; Chen, Liang; Kreiswirth, Barry N.; Riska, Paul F.; Nori, Priya.

In: BMJ Case Reports, Vol. 2018, bcr-2018-225440, 01.01.2018.

Research output: Contribution to journalArticle

Mittal, Jaimie ; Szymczak, Wendy A. ; Guo, Yi ; Levi, Michael H. ; Chen, Liang ; Kreiswirth, Barry N. ; Riska, Paul F. ; Nori, Priya. / Two for the price of one : Emerging carbapenemases in a returning traveller to New York City. In: BMJ Case Reports. 2018 ; Vol. 2018.
@article{ec69110d44534e6ba6e5225e0fbe9b77,
title = "Two for the price of one: Emerging carbapenemases in a returning traveller to New York City",
abstract = "We report a case of a complex orthopaedic infection in a patient returning to New York City from Bangladesh where he was involved in a serious motor vehicle accident. He developed extensive osteomyelitis with a carbapenem-resistant Klebsiella pneumoniae. The isolate was unique due to the coexistence of New Delhi metallo-β-lactamase-1 and Oxacillinase type-181 carbapenemases, which are relatively uncommon in North America and were presumably acquired in Bangladesh. Herein, we explore challenges associated with management of carbapenem-resistant Enterobacteriaceae infections, including limited available data on effective antimicrobial therapy. We also highlight the added value of rapid diagnostic technology in guiding clinical management. Ultimately, the patient required both aggressive surgical management and combination therapy with aztreonam and ceftazidime-avibactam for true source control and favourable clinical outcome.",
keywords = "bone and joint infections, infections",
author = "Jaimie Mittal and Szymczak, {Wendy A.} and Yi Guo and Levi, {Michael H.} and Liang Chen and Kreiswirth, {Barry N.} and Riska, {Paul F.} and Priya Nori",
year = "2018",
month = "1",
day = "1",
doi = "10.1136/bcr-2018-225440",
language = "English (US)",
volume = "2018",
journal = "BMJ Case Reports",
issn = "1757-790X",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Two for the price of one

T2 - Emerging carbapenemases in a returning traveller to New York City

AU - Mittal, Jaimie

AU - Szymczak, Wendy A.

AU - Guo, Yi

AU - Levi, Michael H.

AU - Chen, Liang

AU - Kreiswirth, Barry N.

AU - Riska, Paul F.

AU - Nori, Priya

PY - 2018/1/1

Y1 - 2018/1/1

N2 - We report a case of a complex orthopaedic infection in a patient returning to New York City from Bangladesh where he was involved in a serious motor vehicle accident. He developed extensive osteomyelitis with a carbapenem-resistant Klebsiella pneumoniae. The isolate was unique due to the coexistence of New Delhi metallo-β-lactamase-1 and Oxacillinase type-181 carbapenemases, which are relatively uncommon in North America and were presumably acquired in Bangladesh. Herein, we explore challenges associated with management of carbapenem-resistant Enterobacteriaceae infections, including limited available data on effective antimicrobial therapy. We also highlight the added value of rapid diagnostic technology in guiding clinical management. Ultimately, the patient required both aggressive surgical management and combination therapy with aztreonam and ceftazidime-avibactam for true source control and favourable clinical outcome.

AB - We report a case of a complex orthopaedic infection in a patient returning to New York City from Bangladesh where he was involved in a serious motor vehicle accident. He developed extensive osteomyelitis with a carbapenem-resistant Klebsiella pneumoniae. The isolate was unique due to the coexistence of New Delhi metallo-β-lactamase-1 and Oxacillinase type-181 carbapenemases, which are relatively uncommon in North America and were presumably acquired in Bangladesh. Herein, we explore challenges associated with management of carbapenem-resistant Enterobacteriaceae infections, including limited available data on effective antimicrobial therapy. We also highlight the added value of rapid diagnostic technology in guiding clinical management. Ultimately, the patient required both aggressive surgical management and combination therapy with aztreonam and ceftazidime-avibactam for true source control and favourable clinical outcome.

KW - bone and joint infections

KW - infections

UR - http://www.scopus.com/inward/record.url?scp=85050472764&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050472764&partnerID=8YFLogxK

U2 - 10.1136/bcr-2018-225440

DO - 10.1136/bcr-2018-225440

M3 - Article

C2 - 30021742

AN - SCOPUS:85050472764

VL - 2018

JO - BMJ Case Reports

JF - BMJ Case Reports

SN - 1757-790X

M1 - bcr-2018-225440

ER -