Schwartz I S, Hammond G W
Section of Infectious Diseases, Departments of Internal Medicine and Medical Microbiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.
Can Commun Dis Rep. 2017 Jul 6;43(7-8):150-153. doi: 10.14745/ccdr.v43i78a02.
is a fungal pathogen that has recently emerged as a global threat to public health. It was first described in Japan in 2009 and has since been reported in 17 countries on five continents. This case report describes the first reported case of multidrug-resistant in Canada. In May 2017, a 64-year-old individual was evaluated for chronic otitis externa. Past medical history included a recent hospitalization in India for elective oral surgery that was complicated by an odontogenic brain abscess. Upon return to Canada, the individual was admitted to a hospital for neurosurgical drainage of the brain abscess and parenteral antibiotics. Early during hospitalization, the patient was identified as a carrier of carbapenem-resistant and was placed on contact precautions. Also early during this hospitalization, a chronic otitis media was managed with placement of a typanostomy tube with drainage of clear fluid from the ear, which continued through the admission and after discharge to a post-neurosurgical rehabilitation facility. During outpatient follow-up, swabs of the ear discharge cultured that was resistant to fluconazole and amphotericin B. There was no clinical response to ototopical antifungal therapy. Surgical evaluation for management of the otomastoiditis is pending. There is a potential for to cause infection in health care settings. It can persist in hospital environments, has the potential for transmission and can cause invasive disease. It is difficult to identify and is often resistant to antifungal medications. The application of infection prevention and control recommendations can help prevent nosocomial transmission. It is now prudent to consider the risk of in addition to the known risk of other antimicrobial resistant organisms, in any traveller who has been hospitalized while outside the country. When identified, contacting local public health can assist in the tracking and management of this emerging disease.
是一种真菌病原体，最近已成为对公共卫生的全球威胁。它于2009年在日本首次被描述，此后在五大洲的17个国家都有报告。本病例报告描述了加拿大首例报告的多重耐药病例。2017年5月，一名64岁的患者因慢性外耳道炎接受评估。既往病史包括近期在印度因择期口腔手术住院，术后并发牙源性脑脓肿。回到加拿大后，该患者因脑脓肿接受神经外科引流和静脉注射抗生素治疗而入院。住院早期，患者被确定为耐碳青霉烯类的携带者，并采取了接触预防措施。同样在住院早期，慢性中耳炎通过放置鼓膜造孔管并引流耳内清亮液体进行处理，这种情况在入院期间以及出院后转至神经外科康复机构后仍持续存在。在门诊随访期间，耳部分泌物拭子培养出对氟康唑和两性霉素B耐药的 。耳用抗真菌治疗无临床反应。耳乳突炎的手术评估尚在进行中。 在医疗保健环境中有可能引起感染。它可在医院环境中持续存在，有传播的可能性，并可导致侵袭性疾病。它难以识别，且通常对抗真菌药物耐药。应用感染预防和控制建议有助于预防医院内传播。对于任何在国外住院过的旅行者，除了已知的其他抗菌药物耐药菌的风险外，现在谨慎考虑 的风险是明智的。一旦发现，联系当地公共卫生部门可协助追踪和管理这种新出现的疾病。
