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

BMJ Case Reports
Jaimie MittalPriya Nori

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.

References

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Citations

Nov 14, 2019·The Journal of Antimicrobial Chemotherapy·Siqiang NiuLiang Chen
Jan 21, 2021·Tropical Medicine and Infectious Disease·Hamid BokharyGrant A Hill-Cawthorne

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