Two for the price of one: Emerging carbapenemases in a returning traveller to New York City

Jaimie Mittal, Wendy A. Szymczak, Yi Guo, Michael H. Levi, Liang Chen, Barry N. Kreiswirth, Paul F. Riska, Priya Nori

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


We report a case of a complex orthopaedic infection in a patient returning to New York City from Bangladesh where he was involved in a serious motor vehicle accident. He developed extensive osteomyelitis with a carbapenem-resistant Klebsiella pneumoniae. The isolate was unique due to the coexistence of New Delhi metallo-β-lactamase-1 and Oxacillinase type-181 carbapenemases, which are relatively uncommon in North America and were presumably acquired in Bangladesh. Herein, we explore challenges associated with management of carbapenem-resistant Enterobacteriaceae infections, including limited available data on effective antimicrobial therapy. We also highlight the added value of rapid diagnostic technology in guiding clinical management. Ultimately, the patient required both aggressive surgical management and combination therapy with aztreonam and ceftazidime-avibactam for true source control and favourable clinical outcome.

Original languageEnglish (US)
Article numberbcr-2018-225440
JournalBMJ case reports
StatePublished - 2018


  • bone and joint infections
  • infections

ASJC Scopus subject areas

  • Medicine(all)


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