Rare Antibiotic-Resistant Infection Found in Wyoming Patient

Troy Brown, RN

January 11, 2019

Enterobacteriaceae with a rare antibiotic-resistant gene, mcr-1, was found in a patient at a Wyoming hospital, according to a statement Wednesday from the Wyoming Department of Health (WDH).

The Wyoming Public Health Laboratory, part of WDH, conducted testing that assisted with identifying the nature of the infection, and a federal Centers for Disease Control and Prevention (CDC) network laboratory confirmed the infection.

The patient was undergoing care at Cheyenne Regional Medical Center (CRMC), but it does not appear the patient became infected while at the hospital.

"Thankfully, the patient continues to receive care, has responded to treatment, and is in good condition," said HooFeng Choo, MD, infectious disease specialist at CRMC.

The mcr-1 gene makes bacteria resistant to colistin, a powerful antibiotic. China reported the first mcr-1 gene in November 2015, according to the CDC, and by February 2017 it was "pervasive" in China, as reported by Medscape Medical News.

In January 2017, Medscape Medical News reported on a form of Carbapenem-resistant Enterobacteriaceae with resistance to all antibiotics in the US that was identified in a woman admitted to an acute care hospital in Reno, Nevada, in August 2016. That strain of bacteria was also resistant to colistin but did not contain the mcr-1 gene. The woman had been in India for an extended period and been hospitalized there multiple times. She died in September 2016.

Alexia Harrist, MD, PhD, state health officer and state epidemiologist with the WDH, said the infection is quite rare and potentially serious.

"When bacteria become antibiotic-resistant, then certain categories of antibiotic medicines will not work to kill the bacteria to treat an infection," she said. "In this case, the organism found is resistant to a category of antibiotics sometimes described as 'last resort' medications used to fight infections. The gene found with this patient has been identified in only a handful of states over the past few years," she explained.

As of November 2, the mcr-1 gene has been identified in human isolates in 19 states in the US and in animal isolates in two states, according to the CDC.

"We are working closely with the hospital to prevent the spread of this bacteria," Harrist continued. "Although this finding is unexpected and something we are taking seriously, we believe the contact precautions already in place at the hospital have likely limited the potential spread of the bacteria." Contact precautions require those who enter the patient's room to wear protective gloves and clothing and to observe strict handwashing practices.

Epidemiologists at WDH are working with CRMC to examine the hospital's infection control program, Harrist added. "We all want to be extremely cautious. Together with hospital staff, we will review potential exposures to the organism and work to test anyone found to be at risk," she said. "While antibiotic resistance is a growing overall problem for public health, there should be no concern for local residents because of this incident."

"Wyoming's hospital testing guidelines and public health surveillance system are meant to discover these rare organisms so the hospital and public health can work quickly to limit spread as much as possible," Harrist said. "That's exactly what we are doing with this incident."

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