This study identified the first case of a KPC-producing Klebsiella pneumoniae isolate in Singapore. Rectal screening of 201 patients identified one KPC-producing K. pneumoniae isolate. Genetic analysis found the isolate carried blaKPC-2 and belonged to the globally disseminated ST11 clone. The isolate was obtained from an elderly woman in the local community with no recent travel or antimicrobial drug use, suggesting potential community acquisition and dissemination. Widespread screening and infection control are needed to prevent further spread of this multidrug resistant organism between hospitals and long-term care facilities.
Shifting paradigms in vaccinology immune modulation and sex differences explo...WAidid
Even there are very limited immunological studies to date, Professor Flanagan explains the new paradigms in vaccinology exploring sex differences:
- Vaccines have non-targeted heterologous effects on innate and adaptive immunity
- These can alter susceptibility to non-vaccine targeted infectious diseases and can alter all cause mortality
- Females are more susceptible
Professor Flanagan concludes the slideset with the need to understand mechanisms in order to exploit beneficial and avoid harmful effects.
Incidence rate of multidrug-resistant organisms in a tertiary care hospital, ...Apollo Hospitals
Antimicrobial resistance to microorganisms is a growing public health concern globally, especially in developing countries. This study was conducted to study the incidence rate of multidrug-resistant organisms with their antibiotic sensitivity pattern.
Shifting paradigms in vaccinology immune modulation and sex differences explo...WAidid
Even there are very limited immunological studies to date, Professor Flanagan explains the new paradigms in vaccinology exploring sex differences:
- Vaccines have non-targeted heterologous effects on innate and adaptive immunity
- These can alter susceptibility to non-vaccine targeted infectious diseases and can alter all cause mortality
- Females are more susceptible
Professor Flanagan concludes the slideset with the need to understand mechanisms in order to exploit beneficial and avoid harmful effects.
Incidence rate of multidrug-resistant organisms in a tertiary care hospital, ...Apollo Hospitals
Antimicrobial resistance to microorganisms is a growing public health concern globally, especially in developing countries. This study was conducted to study the incidence rate of multidrug-resistant organisms with their antibiotic sensitivity pattern.
Variable transcriptional adaptation between the laboratory (H37Rv) and clinic...Santhi Devasundaram
The remarkable success of M. tuberculosis as a pathogen is largely due to its ability to
persist within the host for long periods. To develop the effective intervention strategies, understanding the biology
of persistence is highly required. Accumulating evidences showed oxygen deprivation (hypoxia) as a potential
stimulus for triggering the transition of M. tuberculosis to a non-replicating persistent state analogous to
latency in vivo. To date, in vitro hypoxia experimental models used the laboratory adapted isolate H37Rv and
very little is known about the behavior of clinical isolates that are involved during disease outbreaks. Hence,
we compared the transcription profiles of H37Rv and two south Indian clinical isolates (S7 and S10) under hypoxia
to find differences in gene expression pattern.
Role of soluble urokinase plasminogen activator receptor (suPAR) as prognosis...IOSR Journals
Biological marker suPAR was used in many pathological conditions, including infection. suPAR
was correlated with the severity of sepsis. The purpose of this study to determine levels of suPAR infants with
risk of infection as a prognostic indicator for sepsis. Groups of infants with the risk of infection (n = 43) were
followed prospectively on days 0, 3rd and 7th and observed for the incidence of sepsis compared to the control
group (n = 10). suPAR was measured by ELISA and the course of infection measured by clinical criteria.
Results suPAR day 0, 3 and 7, displayed in the form of bloxpot and AUC as prognostic power. suPAR control
levels 9.32 ng / mL, sepsis cutoff 15, 41 ng / mL and AUC of 80.3% [95% CI 65.7%, 94.9%, p = 0.00]. Graph
shows ROC AUC sepsis suPAR day 0, the 3rd and 7th respectively 61.9%, 66.6% and 94.4%. Sepsis with
improved output 16.53 ng / mL and worsening 22.19 ng / mL and AUC of 80.8% [95% CI (0.62 to 0.99), p =
0.02]. suPAR levels was increased in neonatal sepsis patients. suPAR could be used as a prognostic factor for
neonatal sepsis.
Patologie digestive, extradigestive e MicrobiotaASMaD
Presentazione a cura del Professor Giovanni Barbara - M.A.S.T.E.R. ECM in Gastroenterologia: Focus on: Microbiota e dintorni - Fondazione Santa Lucia - Roma
Variable transcriptional adaptation between the laboratory (H37Rv) and clinic...Santhi Devasundaram
The remarkable success of M. tuberculosis as a pathogen is largely due to its ability to
persist within the host for long periods. To develop the effective intervention strategies, understanding the biology
of persistence is highly required. Accumulating evidences showed oxygen deprivation (hypoxia) as a potential
stimulus for triggering the transition of M. tuberculosis to a non-replicating persistent state analogous to
latency in vivo. To date, in vitro hypoxia experimental models used the laboratory adapted isolate H37Rv and
very little is known about the behavior of clinical isolates that are involved during disease outbreaks. Hence,
we compared the transcription profiles of H37Rv and two south Indian clinical isolates (S7 and S10) under hypoxia
to find differences in gene expression pattern.
Role of soluble urokinase plasminogen activator receptor (suPAR) as prognosis...IOSR Journals
Biological marker suPAR was used in many pathological conditions, including infection. suPAR
was correlated with the severity of sepsis. The purpose of this study to determine levels of suPAR infants with
risk of infection as a prognostic indicator for sepsis. Groups of infants with the risk of infection (n = 43) were
followed prospectively on days 0, 3rd and 7th and observed for the incidence of sepsis compared to the control
group (n = 10). suPAR was measured by ELISA and the course of infection measured by clinical criteria.
Results suPAR day 0, 3 and 7, displayed in the form of bloxpot and AUC as prognostic power. suPAR control
levels 9.32 ng / mL, sepsis cutoff 15, 41 ng / mL and AUC of 80.3% [95% CI 65.7%, 94.9%, p = 0.00]. Graph
shows ROC AUC sepsis suPAR day 0, the 3rd and 7th respectively 61.9%, 66.6% and 94.4%. Sepsis with
improved output 16.53 ng / mL and worsening 22.19 ng / mL and AUC of 80.8% [95% CI (0.62 to 0.99), p =
0.02]. suPAR levels was increased in neonatal sepsis patients. suPAR could be used as a prognostic factor for
neonatal sepsis.
Patologie digestive, extradigestive e MicrobiotaASMaD
Presentazione a cura del Professor Giovanni Barbara - M.A.S.T.E.R. ECM in Gastroenterologia: Focus on: Microbiota e dintorni - Fondazione Santa Lucia - Roma
IJRET : International Journal of Research in Engineering and Technology is an international peer reviewed, online journal published by eSAT Publishing House for the enhancement of research in various disciplines of Engineering and Technology. The aim and scope of the journal is to provide an academic medium and an important reference for the advancement and dissemination of research results that support high-level learning, teaching and research in the fields of Engineering and Technology. We bring together Scientists, Academician, Field Engineers, Scholars and Students of related fields of Engineering and Technology
IJRET : International Journal of Research in Engineering and Technology is an international peer reviewed, online journal published by eSAT Publishing House for the enhancement of research in various disciplines of Engineering and Technology. The aim and scope of the journal is to provide an academic medium and an important reference for the advancement and dissemination of research results that support high-level learning, teaching and research in the fields of Engineering and Technology. We bring together Scientists, Academician, Field Engineers, Scholars and Students of related fields of Engineering and Technology.
Novatti International Remittance brochureselnekave
The Novatti International Remittance solution is a stored value account system that creates a “digital wallet” linked to a consumer’s mobile phone that is reliable and easy to use. The application enables a mobile phone to become a secure transaction gateway. In conjunction with operators and banks, this can be used to provide mobile money transfer, remittance and other mobile money services.
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8003154730 or 800-315-4730 (skivoipllc) is a leading VoIP service provider.This presentation contains information about frequently asked questions about skivoipllc or 8003154730.
Fluoroquinolone resistant rectal colonization predicts risk of infectious com...TC İÜ İTF Üroloji AD
Fluoroquinolone resistant rectal colonization predicts risk of infectious complications after transrectal prostate biopsy. Evidence based on journal club by Samed Verep
Successful treatment of two cases of Elizabethkingia meningoseptica septicemi...Apollo Hospitals
Elizabethkingia meningoseptica is emerging as a cause of hospital acquired infection particularly in immunocompromised adults. The treatment of this bacterium is difficult since it is intrinsically resistant to a number of antibiotics. Here we report two cases of septicemia in patients who were critically ill and were successfully treated with appropriate antibiotics. Cotrimoxazole, quinolones, and rifampicin seem to be drugs effective against E. meningoseptica. Antibiotic susceptibility results are ineffective in guiding treatment. The bacterium particularly colonizes water pipelines and tap faucets and occurrence of infection by this bacterium should direct attention towards eradicating the source of this bacterium.
El Tratamiento de bacteriuria asintomatica se asocia con alta prevalencia de ...Alex Castañeda-Sabogal
El Tratamiento de la bacteriuria asintomática con antibióticos está asociado con aparición de cepas resistentes a antibióticos!!!! Publicado el 4 de setiembre del 2015 en Clinical Infectious Diseases
Austin Virology and Retrovirology is an international scholarly peer reviewed Open Access journal, aims to promote the research in the field of Virology.
Austin Virology and Retrovirology is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Case Reports, Short Communications, Perspectives (Editorials), Clinical Images
Austin Virology and Retrovirology supports the scientific modernization and enrichment in virology research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
GeneXpert MTB/RIF: A Useful Tool for Rapid and Accurate Diagnosis of Tubercul...komalicarol
The primary objective of this study was to show the usefulness and
importance of GeneXpert MTB/RIF, a rapid test that simultaneously detects Mycobacterium tuberculosis complex (MTBC) and
resistance to rifampicin (RIF) in less than 2 hours.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. LETTERS
DOI: http://dx.doi.org/10.3201/eid1808.111826
References
1. Petersen JM, Schriefer ME. Tulare-
mia: emergence/re-emergence. Vet Res.
2005;36:455–67. http://dx.doi.org/10.
1051/vetres:2005006
2. Friend M. Tularemia, 1st ed. Reston
(VA): US Geological Survey, circular
1297; 2006 [cited 2011 Feb 4]. http://
www.nwhc.usgs.gov/publications/tulare-
mia
3. Mörner T, Addison E. Tularemia. In: Wil-
liams ES, Barker IK, editors. Infectious
diseases of wild mammals, 3rd ed. Ames
(IA): Iowa University Press; 2001. p. 303–
12.
4. Kaysser P, Seibold E, Matz-Rensing K,
Pfeffer M, Essbauer S, Splettstoesser
WD. Re-emergence of tularemia in Ger-
many: presence of Francisella tularensis
in different rodent species in endemic ar-
eas. BMC Infect Dis. 2008;8:157. http://
dx.doi.org/10.1186/1471-2334-8-157
5. R program. R Foundation for Statistical
Computing, version 2.13.1. 2011 [cited
2011 Feb 4]. http://ftp5.gwdg.de/pub/
misc/cran
6. Gyuranecz M, Rigó K, Dán Á, Földvári
G, Makrai L, Dénes B, et al. Investigation
of the ecology of Francisella tularensis
during an inter-epizootic period. Vector
Borne Zoonotic Dis. 2011;11:1031–5.
http://dx.doi.org/10.1089/vbz.2010.0091
7. Gyuranecz M, Szeredi L, Makrai L, Fodor
L, Ráczné Mészáros Á, Szépe B, et al. Tu-
laremia of European brown hare (Lepus
europaeus): a pathological, histopatho-
logical and immunhistochemical study.
Vet Pathol. 2010;47:958–63. http://dx.doi.
org/10.1177/0300985810369902
8. World Health Organization. WHO guide-
lines on tularemia. 2007 [cited 2011 Feb
4]. http://www.cdc.gov/tularemia/resourc-
es/whotularemiamanual.pdf
Address for correspondence: Miklós
Gyuranecz, Institute for Veterinary Medical
Research, Centre for Agricultural Research–
Hungarian Academy of Sciences, Hungária
krt. 21, Budapest, H-1143, Hungary; email:
m.gyuranecz@gmail.com
Klebsiella
pneumoniae
Carbapenemase-
producing
Enterobacteria
in Hospital,
Singapore
To the Editor: During the past
decade, enterobacteria that produce
Klebsiella pneumoniae carbapene-
mase (KPC) have become established
in the United States and countries
in South America and Europe (1).
In Asia, KPC was reported in the
People’s Republic of China in 2007 (2)
and subsequently in South Korea (3)
and Taiwan (4). Public health agencies
emphasize screening and strict contact
precautions to control multidrug
resistant Enterobacteriaceae (5).
Routine testing for mechanisms
of resistance facilitates detection
of emerging carbapenem-resistant
Enterobacteriaceae.
In Singapore’s 1,000-bed National
University Hospital during November
2010–January 2011, we identified New
Delhimetallo-β-lactamase1–producing
Enterobacteriaceae in 2 clinical
specimens but none that produced KPC
(I. Venkatachalam et al., unpub. data).
We conducted a laboratory screening
study to determine the prevalence
and nature of carbapenem-resistant
Enterobacteriaceae in April 2011.
Ethics committee approval was waived
for this study.
Testing of rectal swab samples
is part of an established hospitalwide
program for vancomycin-resistant
enterococci screening. Using a scoring
system to identify patients at high risk
for vancomycin-resistant enterococci
(6), we found that ≈2.5 specimens per
100 admissions were attained each
month.Duringourstudy,wealsotested
these samples for carbapenemase-
producing Enterobacteriaceae.
During April–June 2011, we
incubated specimens for 24 h in 10
mL tryptic soy broth containing 1
mg/L imipenem, then streaked 100
μL of the broth onto CHROMagar
KPC (CHROMagar, Paris, France).
Colonies detected after 24 h
incubation at 35°C were identified
by using MALDI-TOF MS with a
Microflex LT instrument (Bruker
Daltonik GmbH, Leipzig, Germany).
Imipenem and meropenem MICs for
Enterobacteriacaeae were confirmed
by using Etests (bioMérieux, Marcy
l’Etoile, France). Isolates with MIC
>2 μg/mL underwent analysis with
Metallo-β-Lactamase Confirmative
Identification Pack (Rosco Diag-
nostica, Taastrup, Denmark) and
Etest MBL (bioMérieux) for metallo-
β-lactamase production. Isolates
suspected to be producers were
genotypically confirmed by PCR.
Of the 201 nonduplicate samples
processed, 79 microorganisms ex-
hibited imipenem resistance and
were isolated on CHROMagar KPC
(Table). Among Enterobacteriaceae,
carbapenem MIC >2 μg/mL was
present in 1 E. aerogenes, 2 E. cloacae,
and 4 K. pneumoniae isolates. One
isolate (K. pneumoniae) had a positive
combined disk test result with a pattern
suggestive of serine carbapenemase
production.
We analyzed genomic DNA
(DNeasy Blood and Tissue Kit,
QIAGEN, Hilden, Germany) from this
isolate by using PCR for transmissible
carbapenem resistance markers:
metallo-β-lactamases (VIM, IMP, and
KHM-1), serine carbapenemases
(KPC, GES1–5 and 7), and OXA-
48. blaKPC
-specific primers (for-ward
primer 5′-CGTTGACGCCCAAT
CC-3′; reverse primer 5′-ACCGCT
GGCAGCTGG-3′) generated a 390-bp
amplicon. Full gene sequencing of
blaKPC
(forward primer 5′-ATGTCAC
TGTATCGCCGTCT-3′; reverse primer
5′-CCTAAATGTGACAGTGGT
TGG) revealed 100% homology
to blaKPC-2
(GenBank accession no.
FJ628167.2). Further analysis showed
that the isolate carried extended-
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 8, August 2012 1381
2. LETTERS
spectrum β-lactamase (blaTEM-1
,
blaSHV-11
, blaCTX-M-15
), plasmid-located
AmpC (blaDHA-1
), and 16S rRNA
methylase armA genes but was
negative for blaCMY
, blaOXA
, blaGES
,
metallo-β-lactamases, and plasmid-
mediated quinolone (qnr) genes.
Multilocus sequence typing conducted
at Institut Pasteur (Paris, France),
identified this isolate as sequence type
11. It was susceptible only to colistin
and tigecycline.
Sequence type 11, a single-
locus variant of the internationally
dominant sequence type 258 clone (7),
is present in 64.2% of KPC-producing
K. pneumoniae in China (8). In
South Korea, sequence type 11 is the
most common clone of extended-
spectrum β-lactamase–producing K.
pneumoniae isolates (3).
The KPC-producing K.
pneumoniae originated from a woman
in the local community, 89 years
of age, who had severe ischemic
cardiomyopathy and atrial fibrillation.
She was discharged home after a
3-day hospitalization for treatment
of stroke in January 2011. During
May 2011, she was readmitted after
a severe stroke. During week 4, she
was transferred to a subacute care
hospital but readmitted within 24
hours with a lower respiratory tract
infection. A rectal swab sample was
collected for routine screening for
vancomycin-resistant enterococci.
We empirically prescribed a 10-day
course of piperacillin-tazobactam. On
day 10 of treatment, KPC-producing
K. pneumoniae was isolated from the
rectal specimen.The patient responded
to treatment and was discharged to a
long-term care facility.
This case demonstrates concerns
about a KPC of local community
origin because no other KPC-
producing Enterobacteriaceae
were isolated during this inpatient
surveillance and the patient had
neither received antimicrobial drugs
nor traveled in the 6 months before her
May admission (7). However, she was
admitted 3 weeks before sampling; an
unidentified hospital source remains
a possibility. Of added concern is the
potential for dissemination within the
facility to which she was discharged.
Resistance to third-generation
cephalosporins was reported for 20%
of Escherichia coli, 32.3% of K.
pneumoniae, 46.2% of Acinetobacter
spp., and 7.5% of Pseudomonas
aeruginosa clinical isolates at 4 major
Singapore hospitals during January
2006–December 2008 (9). Authors
reported positive correlation between
meropenem administration and
carbapenem resistance development
in Acinetobacter spp. blood isolates.
When the resistance mechanism
to an antimicrobial drug is embedded
in highly mobile elements like
plasmids, widespread dissemination is
possible.Although acute care hospitals
are conducive to development of
antimicrobial drug resistance, long-
term care facilities facilitate spread
of these organisms (10). Infection
control interventions including
routine screening for mechanisms
of resistance and responsible use of
antimicrobial drugs are increasingly
critical in hospitals and long-term care
facilities; a response plan coordinated
between these facilities is needed.
Acknowledgments
We thank Tan Li Fang, Grace Ngan
Jie Yin, and Janet Cheng for technical
assistance during specimen processing. We
thank all other staff from our microbiology
laboratory for facilitating the conduct of
this study.
This work was supported by a Health
Service Development Programme Grant
provided by the Ministry of Health,
Singapore (grant no. HSDP06/X04).
Indumathi Venkatachalam,
Jeanette Teo,
Michelle N.D. Balm,
Dale A. Fisher, Roland Jureen,
and Raymond T.P. Lin
Author affiliation: National University
Hospital, Singapore
DOI: http://dx.doi.org/10.3201/eid1808.110893
References
1. Nordmann P, Cuzon G, Naas T. The real
threat of Klebsiella pneumoniae car-
bapenemase-producing bacteria. Lancet
Infect Dis. 2009;9:228–36. http://dx.doi.
org/10.1016/S1473-3099(09)70054-4
2. Wei ZQ, Du XX, Yu YS, Shen P, Chen
YG, Li LJ. Plasmid-mediated KPC-2 in
a Klebsiella pneumoniae isolate from
China. Antimicrob Agents Chemother.
2007;51:763–5. http://dx.doi.org/10.1128/
AAC.01053-06
3. Rhee JY, Park YK, Shin JY, Choi JY,
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1382 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 8, August 2012
Table. Bacteria isolated on CHROMagar in screening for carbapenemase-producing
Enterobacteriaceae, Singapore, 2011*
Organism No. isolated
Enterobacteriaceae
Klebsiella pneumoniae 11
Enterobacter cloacae 3
Enterobacter aerogenes 2
Proteus mirabilis 2
Escherichia coli 1
Serratia marcescens 1
Non-Enterobacteriaceae: gram-negative nonfermenters
Pseudomonas aeruginosa 20
Acinetobacter baumannii 17
Stenotrophomonas maltophilia 13
Elizabethkingia meningoseptica 3
Wautersiella falsenii 1
Enterococci
Enterococcus gallinarum 4
Enterococcus faecalis 1
*CHROMagar, Paris, France.
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Address for correspondence: Indumathi
Venkatachalam, National University Hospital–
Infectious Diseases, 5 Lower Kent Ridge Rd,
Singapore City 119074, Singapore; email:
indumathi_venkatachalam@nuhs.edu.sg
blaNDM-1
–positive
Klebsiella
pneumoniae from
Environment,
Vietnam
To the Editor: The blaNDM-1
gene, which produces the New Delhi
metallo-β-lactamase (NDM-1) en-
zyme, confers resistance to the car-
bapenem class of antimicrobial drugs
and can be transferred among different
types of bacteria. NDM-1 was identi-
fied in 2008 in Sweden from a patient
from India who had been hospitalized
in New Delhi (1). Since that report,
blaNDM-1
–positive bacteria have been
identified from patients in several
countries; most of these patients had
a direct link with the Indian subconti-
nent (2). The spread of blaNDM-1
among
bacterial pathogens is of concern not
only because of resistance to carbapen-
ems but also because such pathogens
typically are resistant to multiple an-
timicrobial drug classes, which leaves
few treatment choices available (3–5).
In 2011, spread of blaNDM-1
–positive
bacteria in an environmental setting in
New Delhi was reported (6).
The possible appearance of bac-
teria harboring blaNDM-1
in Vietnam is
of concern because cultural and eco-
nomic links between Vietnam and In-
dia are strongly established, including
extensive person-to-person exchanges
that could enable easy exchange of
pathogens. In addition, Vietnam faces
a serious problem of antimicrobial
drug resistance because drugs are free-
ly available and used in an indiscrimi-
nate fashion. Thus, once blaNDM-1
–
positive bacteria colonize persons in
Vietnam, they would be able to spread
easily and pose a serious public health
threat.
During September 2011, we col-
lected paired swab samples (1 for
PCR, 1 for culture) of seepage water
from 20 sites (rivers, lakes, and water
pools in streets) within a 10-km radius
of central Hanoi, Vietnam. Samples
were transported in Transystem (CO-
PAN Italia S.p.A, Brescia, Italy) to
preserve bacteria and DNA. The 20
PCR swab specimens were squeezed
out into 0.5-mL volumes of sterile wa-
ter and centrifuged at 3,000 × g for 30
seconds; 1 μL of the resulting suspen-
sion was then used as PCR template to
detect blaNDM-1
as described (7). Two
samples were positive for blaNDM-1
;
these 2 samples were collected from
the same river (Kim Nguu River) but
at sites 3 km apart.
To isolate and identify the pheno-
type and genotype of blaNDM-1
–positive
bacteria, we repeatedly spread the 20
culture swab specimens onto Muller-
Hinton agar (Nissui, Tokyo, Japan)
containing 100 mg/L vancomycin
(Nakalai, Kyoto, Japan) plus 0.5 mg/L
meropenem (LKT Laboratories, St.
Paul, MN, USA) until single colonies
were obtained. Each colony was then
subcultured by plating onto MacCon-
key agar (Nihon Seiyaku, Tokyo,
Japan) containing 0.5 mg/L merope-
nem to ensure culture purity; colo-
nies were identified by using API 20E
strips (bioMérieux, Basingstoke, UK).
MICs of these isolates for 13 antimi-
crobial drugs were calculated by using
Etest (bioMérieux), and susceptibility
data were interpreted by using Clini-
cal and Laboratory Standards Institute
guidelines (www.clsi.org).
We harvested several species of
bacteria from the 2 seepage samples
positive for blaNDM-1
: Acinetobacter
baumannii, Klebsiella pneumoniae,
Pseudomonas aeruginosa, P. fluore-
scens/putida, and P. luteola. These
isolates were placed onto media con-
taining 0.5 mg/L meropenem, and
bacterial DNA was extracted and
used for the template for PCR analy-
sis to detect blaNDM-1
as described (7).
blaNDM-1
was detected in 3 K. pneu-
moniae isolates from each of the 2
positive samples (6 isolates total); this
result was confirmed by sequencing.
All 6 isolates were highly resistant
to all β-lactam antimicrobial drugs,
including carbapenems (Table). To
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 18, No. 8, August 2012 1383