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The outbreak, involving 10 patients — all Irish residents aged 44-90 years — was successfully managed by applying enhanced infection prevention and control practices to prevent transmission.
Carbapenemase-producing Enterobacteriaceae (CPE) — resistant to most classes of antibiotics — can cause healthcare-associated infections with high mortality rates, and NDM-1 is a recently discovered variant. Isolates were made from samples taken at University Hospital Limerick and two affiliated regional hospitals 10km and 40km away. Prior to this outbreak, NDM-1 was isolated only sporadically from hospitals throughout Ireland and was typically travel-associated.
The index case was a 44-year-old, community-dwelling female, who was switched to peritoneal dialysis in 2013 after being on haemodialysis for 16 years. She was admitted with peritonitis and E.Coli isolated from blood and peritoneal fluid cultures. A rectal swab taken on admission was CPE-negative, but a further rectal swab taken a week later yielded a positive result. The patient died two months following admission secondary to refractory soft-tissue sepsis. The remaining nine patients were not infected but were colonised.
The authors of the article state: “The source of the index patient’s NDM-1-producer acquisition remains uncertain, although acquisition during the hospital admission of June 2014 is considered likely.”
The outbreak patients did not have a history of travel outside of Ireland, but a number had frequent hospitalisations in Ireland, raising concerns regarding the possibility of increasing but unrecognised prevalence of NDM-1 and potential decline in value of travel history, a marker of colonisation risk. “As the successful management of this outbreak demonstrates, prompt infection prevention and control practices are essential to prevent transmission,” the authors stated.