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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 9) a case of New Delhi metallo-њ-lactamase-5 (NDM-5) and a case of New Delhi metallo-њ-lactamase-1 (NDM-1) Carbapenemase-producing Enterobacteriaceae.
The first patient is a 25-year-old man with good past health. He travelled to Vietnam from March 6 to 12 and was admitted to a local hospital during the trip. He returned to Hong Kong on March 12. He was admitted to Pamela Youde Nethersole Eastern Hospital on March 31 and was discharged on the same day. His condition has been stable all along.
His rectal swab grew NDM-5 Carbapenemase-producing Enterobacteriaceae as confirmed by the PHLSB. His family contacts remained asymptomatic.
The second patient is a 79-year-old man with underlying illnesses. He was admitted to Queen Elizabeth Hospital (QEH) from March 19 to 28 and March 31 to April 3 respectively. He was admitted to QEH again today. He is now in stable condition.
His rectal swab yielded NDM-1 and OXA Carbapenemase-producing Enterobacteriaceae as confirmed by the PHLSB.
Preliminary investigation revealed that the second patient had no recent travel history. This case is classified as colonisation and is linked to a cluster of Carbapenemase-producing Enterobacteriaceae in QEH with three cases (including this patient). One of these three cases, a 65-year old man, had history of admission to healthcare facility in India. Urine specimen taken from this patient on March 25 was positive for OXA Carbapenemase-producing Enterobacteriaceae. The patient subsequently died on March 27.
CHP's investigations are on-going.
These are the 37th and 38th detected cases 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 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 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/Wednesday, April 9, 2014
Issued at HKT 20:59
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