Update: detection of a verona integron-encoded metallo-beta-lactamase in Klebsiella pneumoniae --- United States, 2010.

In July 2010, CDC was notified of a patient with a carbapenem-resistant Klebsiella pneumoniae strain that produced a Verona integron-encoded metallo-beta-lactamase (VIM) carbapenemase not reported previously among Enterobacteriaceae in the United States. The patient was a woman from the United States who became ill with diarrhea during a Mediterranean cruise and was hospitalized in Greece, where she received a diagnosis of sepsis and Clostridium difficile infection. After 12 days in two hospitals in Greece, she was transferred to a hospital in the United States for continued management of sepsis and acute renal failure. On admission, blood was drawn for culture through a central venous catheter that had been placed while the patient was hospitalized in Greece. The blood subsequently grew carbapenemase-producing Klebsiella pneumoniae exhibiting the VIM resistance mechanism, which has been described previously in Greece but not in the United States. Further testing showed the isolate to be nonsusceptible to all antimicrobials usually used to treat Klebsiella. Despite the resistance of the Klebsiella strain, the patient recovered sufficiently to be discharged after 26 days in the U.S. hospital. A search for other patients colonized with the same isolate was conducted by screening 22 patients whose U.S. hospital stays overlapped with this patient; no carbapenem-resistant Enterobacteriaceae (CRE) were detected.