Press Release
Two cases of NDM Carbapenemase-producing Enterobacteriaceae under CHP investigation
3 May 2014
The Public Health Laboratory Services Branch (PHLSB) of the Centre for Health Protection (CHP) of the Department of Health confirmed today (May 3) two cases of New Delhi metallo-β-lactamase (NDM) Carbapenemase-producing Enterobacteriaceae.
The first case, a 76-year-old man with underlying illnesses, was admitted to Queen Elizabeth Hospital (QEH) on April 19 for pneumonia and is currently in stable condition. His rectal swab grew NDM and OXA Carbapenemase-producing Enterobacteriaceae as confirmed by the PHLSB.
The second case, an 81-year-old man with underlying illnesses, was admitted to QEH on April 17 for influenza and was transferred to Kowloon Hospital on April 29. He is currently in stable condition. His rectal swab grew NDM Carbapenemase-producing Enterobacteriaceae as confirmed by the PHLSB.
Preliminary investigation revealed that the two patients had no recent travel history. They have been classified as colonisation and were linked to a cluster of Carbapenemase-producing Enterobacteriaceae in QEH, amounting to eight cases (including these two patients). One of these eight 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 four patients in this cluster, four men aged 79, 87, 78 and 75, were confirmed to have NDM-1 and OXA Carbapenemase-producing Enterobacteriaceae colonisation on April 9, 17, 25 and 29 respectively.
The CHP's investigations are ongoing.
These are the 42nd and 43rd 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.