Antimicrobial Resistant Bacteria as Reportable Diseases: An Update
Recently the University of Pennsylvania, Ryan Veterinary Teaching Hospital experienced an outbreak of an NDM-5 carbapenemase producing E. coli infections originating in the ICU. One of the most significant types of gram negative resistance, it eliminates use of the carbapenem class, including imipenem and meropenem, a last line therapy in human medicine. In addition, this type of carbapenemase enzyme had not been reported in the USA in either human or veterinary medicine, which made it novel in this country. Not only did the isolation of a carbapenem resistant Enterobacteriaceae (CRE) (in this case E. coli) significantly impact the Ryan Hospital patients, it also impacted the Hospital in an unexpected way. As CRE is reportable to the Philadelphia Department of Health, a DOH investigation was pursued which culminated in significant involvement of human Public Health agencies in management of the outbreak investigation.
Why is this important? Washington State Dept. of Health also requires reporting of CRE and other high consequence resistant bacteria from veterinary laboratories and veterinarians. While CRE is still uncommon in veterinary medicine it is likely to become more common as we treat increasing numbers of critical and immunosuppressed patients. The risk to owners and care-givers of infected or colonized animals with these bacteria is difficult to know, but the Dept. of Health may want to investigate veterinary cases if public health is perceived to be impacted. Therefore, it is important to understand what is on the Dept. of Health reportable list, and to be aware of the roles of public health in a veterinary setting.
As this type of resistant bacteria can have significant consequences to patient health and hospital biosecurity, development or review of biosecurity protocols for clinics and hospitals, including notification schemes, will help reduce spread and stress.
Below are links to the PennVet website with more information about the outbreak and the WADOH notifiable conditions webpage.
- Carbapenem-resistant Enterobacteriaceae Frequently Asked Questions
- Washington State Department of Health List of Notifiable Conditions
By Claire Burbick, DVM, PhD, DACVM, Clinical Assistant Professor, Section Head, Bacteriology and Parasitology, Washington Animal Disease Diagnostic Laboratory
Posted August 16, 2019