Toomer Kevin H, de Lima Corvino Daniela, McCrink Katie A, Gonzales Zamora Jose Armando
Infectious Diseases Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, USA.
IDCases. 2020 May 12;21:e00816. doi: 10.1016/j.idcr.2020.e00816. eCollection 2020.
The New Delhi metallo-β-lactamase (NDM) is a mediator of broad antimicrobial resistance among the and other gram-negative pathogens that cause opportunistic and nosocomial infections. In the decade since its discovery, NDM has spread worldwide and represents an increasing threat to public health. NDM is capable of hydrolyzing nearly all known β-lactam antibiotics, including the carbapenems, and due to its zinc ion-dependent catalytic mechanism is unaffected by available β-lactamase inhibitors. We report a case of catheter-related bloodstream infection caused by a pan-resistant, NDM-positive isolate of in an ambulatory end-stage renal disease patient started on hemodialysis approximately 8 weeks prior. The absence of any recent hospitalization indicates that the infection was likely acquired from a hemodialysis center in the United States. This case demonstrates the increasing prevalence of antimicrobial resistance mechanisms in ambulatory as well as inpatient healthcare settings, and highlights the particular risk of the outpatient hemodialysis facility as an optimal environment for colonization with multidrug- and pandrug-resistant pathogens.
新德里金属β-内酰胺酶（NDM）是导致机会性感染和医院感染的肠杆菌科细菌及其他革兰氏阴性病原体广泛耐药的介导因子。自发现以来的十年间，NDM已在全球传播，对公共卫生构成日益严重的威胁。NDM能够水解几乎所有已知的β-内酰胺抗生素，包括碳青霉烯类，并且由于其锌离子依赖性催化机制，不受现有β-内酰胺酶抑制剂的影响。我们报告了一例由泛耐药、NDM阳性的肠杆菌科细菌引起的导管相关血流感染病例，该患者为门诊终末期肾病患者，约8周前开始接受血液透析。近期无住院史表明感染可能来自美国的一家血液透析中心。该病例表明门诊及住院医疗环境中抗菌耐药机制的患病率不断上升，并突出了门诊血液透析设施作为多重耐药和泛耐药病原体定植的最佳环境的特殊风险。
