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Case of NDM-1 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 (April 29) a case of New Delhi metallo-]-lactamase-1 (NDM-1) affecting a 75-year-old man.

     The patient, with underlying illnesses, was admitted to Queen Elizabeth Hospital (QEH) on April 3 for hypoglycemia. He was discharged from QEH on April 13. He was admitted to Wong Tai Sin Hospital on April 19 for rehabilitation and is currently in stable condition.

     His rectal swab grew NDM-1 and OXA Carbapenemase-producing Enterobacteriaceae as confirmed by the PHLSB.

     Preliminary investigation revealed that the patient had no recent travel history. This case has been classified as colonisation and is linked to a cluster of Carbapenemase-producing Enterobacteriaceae in QEH, amounting to six cases (including this patient). One of these six cases, a 65-year-old man, had a history of admission to a health-care facility in India. A urine specimen taken from this patient on March 25 tested positive for OXA Carbapenemase-producing Enterobacteriaceae. The patient subsequently died on March 27. Another three patients in this cluster, three men aged 79, 87 and 78, were confirmed to have NDM-1 and OXA Carbapenemase-producing Enterobacteriaceae colonisation on April 9, 17 and 25 respectively.

     The CHP's investigations are ongoing.

     This is the 41st detected case of NDM Carbapenemase-producing Enterobacteriaceae in Hong Kong.

     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 vary 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 spokesman 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, April 29, 2014
Issued at HKT 17:41

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