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Case of NDM-4 Carbapenemase-producing Enterobacteriaceae under CHP investigation
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     The Public Health Laboratory Services Branch (PHLSB) of the Centre for Health Protection (CHP) of the Department of Health confirmed today (January 15) a case of New Delhi metallo-]-lactamase-4 (NDM-4) Carbapenemase-producing Enterobacteriaceae in a 73-year-old man.

     The patient with chronic illness travelled to New Delhi, India, on December 26, 2012. He developed symptoms of fever, shortness of breath and productive cough on December 28 and therefore sought medical attention at a local hospital without hospitalisation.

     Upon arrival in Hong Kong, he sought medical consultation from another private doctor on January 3, 2013 and was admitted to Princess Margaret Hospital (PMH) on January 8. The clinical diagnosis was bronchitis and he was discharged on January 10. His condition remains stable.

     The patient's rectal swab grew NDM-4 Carbapenemase-producing Enterobacteriaceae, as confirmed by the PHLSB.

     His family contacts are asymptomatic. The CHP's investigation is under way.

     This is the 18th detected case of NDM Carbapenemase-producing Enterobacteriaceae in Hong Kong and is the first NDM-4 case reported to the CHP.

     "NDM-4 is a variant of NDM found in India," a CHP spokesperson said.

     NDM is an enzyme which can inactivate carbapenems and other beta-lactams such as penicillins. Bacteria harbouring this NDM gene are commonly resistant to multiple antimicrobials, limiting therapeutic options and rendering severe clinical infections difficult to treat. Most bacteria with the NDM enzyme remain susceptible to two types of antibiotics, colistin and tigecycline.

     Infections have varied from being asymptomatic to potentially life-threatening or fatal. The level of risk depends on which part of the body is affected by the infection, and the general health of the patient.

     NDM-producing Enterobacteriaceae was first reported in a Swedish patient of Indian origin who travelled to New Delhi, India, in 2008. The first fatal case was identified in 2010 in a patient who received medical treatment in Pakistan before being repatriated to Belgium.

     NDM-producing Enterobacteriaceae has now been reported in many countries and regions including Australia, Austria, Canada, Belgium, France, Germany, Japan, the Netherlands, Norway, Oman, Sweden, Singapore, Taiwan, the UK and the US. Most patients had prior hospital contact in the Indian subcontinent.

     A CHP spokesperson said that proper use of antibiotics and personal hygiene, especially hand hygiene, are important for the prevention of emergence and cross-transmission of NDM strains.

Ends/Tuesday, January 15, 2013
Issued at HKT 20:06

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