A woman in Reno, Nevada, has died from an infection resistant to all kinds of antibiotic available in the United States.

Patient Hospitalized Several Times In India

In a report published in the Morbidity and Mortality Weekly Report of the U.S. Centers for Disease Control and Prevention, Lei Chen, from Washoe County Health District, Nevada, and colleagues reported the case of a woman in her 70s who recently returned to the United States in early August after visiting India.

The woman was hospitalized on Aug. 18 and was diagnosed with systemic inflammatory response syndrome characterized by high heart rate, fever, abnormal white blood cell count and an abnormal breathing rate, which occurs as response to infection or some forms of trauma.

Prior to her return to the United States, the woman had already been hospitalized several times in India because of a fractured femur. The woman, who had gotten infection in her hip and thigh bone, was last hospitalized in India in June.

Carbapenem-Resistant Enterobacteriaceae

On Aug. 19, doctors were able to isolate a sample of a known antibiotic-resistant superbug called carbapenem-resistant Enterobacteriaceae from the patient.

Enterobacteriaceae is a bacteria normally found in the human gut, but carbapenem-resistant bacteria Enterobacteriaceae does not succumb the carbapenems, a class of antibiotics that doctors consider to be the last line of defense against bacterial infections.

New Delhi Metallo-Beta-Lactamase

While searching for a potential cure for the woman's infection, the doctors realized that the bacteria was resistant to all 14 antibiotics that the facility had.

Subsequent CDC testing revealed that the germ was a highly resistant form of CRE typically found outside of the country, the New Delhi metallo-beta-lactamase. The bacteria is in fact resistant not just to 14 antibiotics but to all the 26 antibiotics that are available in the United States. The patient eventually developed sepsis and died in September.

"Antimicrobial susceptibility testing in the United States indicated that the isolate was resistant to 26 antibiotics, including all aminoglycosides and polymyxins tested, and intermediately resistant to tigecycline," reported Chen and colleagues.

Highly Dangerous Infections In Foreign Hospitals

Doctors said that the case highlights the fact that patients who were treated in hospitals in other countries may acquire highly dangerous infections. The unnamed patient had inpatient health care exposure in India before she was treated in the United States.

Randall Todd, the director of epidemiology and public health preparedness for the Washoe County Health District, said that health care practices in hospitals in other countries may not be at par with those in the U.S. hospitals, and this can help spread the superbug.

Health experts said that the case highlights the importance of infection control because these bugs also pose serious threats to other patients in the hospital.

"Our planet seems to be getting smaller and smaller," Todd said. "So when a patient presents, it's important to take a thorough history and know where else in the world they've been, and have some idea of what they might have been exposed to and what they might be bringing in to your facility."

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