On January 14, 2010, Taiwan CDC confirmed this year’s first case of New Delhi metallo-β-lactamase 1 Enterobacteriaceae infection (NDM-1 Enterobacteriaceae infection).The case is a 56-year-old male with a history of uremia.In October, 2010, he traveled to Jiangxi, China for a kidney transplant.In late October, the case returned to Taiwan and the case sought medical attention at a hospital due to lower abdominal pain.An abdominal MRI showed an accumulation of fluid in the abdominal cavity.On November 5, 2010, he was treated with drainage.The drainage fluid was collected for bacteria culture and identification. The laboratory test results showed that the drainage fluid was culture-positive for carbapenem resistant Klebsiella pneumoniae.Subsequently, the drainage fluid collected on November 17 and the urine samples collected on November 27 and December 21 were all culture-positive for carbapenem resistant Klebsiella pneumoniae.The isolated carbapenem resistant Klebsiella pneumoniae was screened for drug resistant-associated genes by the drug resistance monitoring system in the hospital and the bacteria was highly suspected to carry the NDM-1 gene.On January 10, 2011, the hospital reported the case to the health authority as required by law.As the hospital always implements all relevant infection control measures such as isolation/quarantine when a carbapenem-resistant Enterobacteriaceae case is discovered, the abovementioned case has been receiving medical treatment in a single room since his admission to the hospital.During October to December, 2010, the case was the only case tested culture-positive for carbapenem-resistant Enterobacteriaceae (CRE) in the hospital.Thus far, no evidence has shown nosocomial transmission of the bacteria has occurred in the hospital.In Taiwan, Taiwan CDC, major medical centers and research institutes keep about 1,000 CRE strains in collection and no NDM-1-positive Enterobacteriaceae has been isolated from any of the strains.Therefore, the case is suspected to be an imported case though more information is needed to confirm that.

Antimicrobial resistance and its spread remain global public health issues.This year, the World Health Organization (WHO) has adopted antimicrobial resistance and its spread as the theme for the World Health Day 2011, which is held annually on April 7. WHO has devised four major approaches to combat drug resistance, including: 1. Establishing a drug resistance reporting mechanism, 2. Ensuring the rational use of antibiotics and providing antibiotic education, 3. Establishing regulations for antibiotic usage, 4. Reinforcing infection control capacity in hospitals/medical institutions.Taiwan CDC has planned relevant disease control policies in line with WHO’s approaches for combating drug resistance, including continuing to promote hand hygiene in healthcare settings and standard guidelines for isolation and quarantine as well as promoting the establishment of drug resistance and nosocomial infection monitoring systems in hospitals and medical institutions in Taiwan .

NDM-1 Enterobacteriaceae infection was listed as a Category IV Notifiable Infectious Disease on September 9, 2010. Taiwan CDC urges all medical institutions to stay vigilant about NDM-1 Enterobacteriaceae infection and report any suspected case who has recently traveled overseas, especially for invasive medical treatment such as surgery or wound treatment, and is culture positive for carbapenem resistant Klebsiella pneumoniae within 24 hours of diagnosis or detection.Taiwan CDC once again reminds all medical institutions to further promote awareness and prevention of NDM-1 Enterobacteriaceae infection in their institutions.

For more information on NDM-1 Enterobacteriaceae infection, please visit the Taiwan CDC’s website: http://www.cdc.gov.tw/ or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922.