Volume 98, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



A Syrian asylum seeker with multidrug–resistant tuberculosis (TB) developed a bronchopleural fistula after pneumonectomy. Although screening tests were negative on admission, carbapenemase-producing Enterobacteriaceae were cultured after a few months of TB treatment. Prevalence of multidrug–resistant organisms is reported to be increased in asylum seekers compared with the general Dutch population. Arduous conditions during transit and interrupted health care delivery in our patient led to multiple-resistant microorganisms that complicated treatment.


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  1. Akkerman OW, de Lange WC, Schölvinck EH, Wolters B, Aartsma Y, van der Werf TS, van Hest R, 2016. Implementing tuberculosis entry screening for asylum seekers: the Groningen experience. Eur Respir J 48: 261264.
    [Google Scholar]
  2. Heudorf U, Albert-Braun S, Hunfeld KP, Birne FU, Schulze J, Strobel K, Petscheleit K, Kempf VA, Brandt C, 2016. Multidrug-resistant organisms in refugees: prevalences and impact on infection control in hospitals. GMS Hyg Infect Control 11: Doc16.
    [Google Scholar]
  3. Alsaad N, van Altena R, Pranger AD, van Soolingen D, de Lange WC, van der Werf TS, Kosterink JG, Alffenaar JW, 2013. Evaluation of co-trimoxazole in the treatment of multidrug-resistant tuberculosis. Eur Respir J 42: 504512.
    [Google Scholar]
  4. Werkgroep Infectie Preventie, 2012. Meticilline-Resistente Staphylococcus aureus (MRSA). Available at: http://www.rivm.nl/dsresource?objectid=3f054354-ff4a-43ef-91f9-7c6f0417be95&type=org&disposition=inline. Accessed May 22, 2017.
  5. Mascini E, Hendrix R, Vos G, Cohen Stuart J, 2015. Correctie in Alinea Over Meldingsplichtig–Alertheid Gevraagd Voor Mogelijk Risico van MRSA/BRMO-Dragerschap Onder Asielzoekers. Available at: http://www.rivm.nl/dsresource?objectid=06625bb2-ab97-440c-8087-f03c9b540d17&type=org&disposition=inline. Accessed May 22, 2017.
  6. Hargreaves S, Lönnroth K, Nellums LB, Olaru ID, Nathavitharana RR, Norredam M, Friedland JS, 2017. Multidrug-resistant tuberculosis and migration to Europe. Clin Microbiol Infect 23: 141146.
    [Google Scholar]
  7. Reinheimer C, Kempf VA, Göttig S, Hogardt M, Wichelhaus TA, O’Rourke F, Brandt C, 2016. Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June–December 2015. Euro Surveill 21: 30110.
    [Google Scholar]
  8. Heudorf U, Krackhardt B, Karathana M, Kleinkauf N, Zinn C, 2016. Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015. Euro Surveill 21: 30109.
    [Google Scholar]
  9. van Altena R et al., 2016. Shorter treatment for multidrug-resistant tuberculosis: the good, the bad and the ugly. Eur Respir J 48: 18001802.
    [Google Scholar]
  10. Van Altena R, de Vries G, Haar CH, de Lange WC, Magis-Escurra C, van den Hof S, van Soolingen D, Boeree MJ, van der Werf TS, 2015. Highly successful treatment outcome of multidrug-resistant tuberculosis in the Netherlands, 2000–2009. Int J Tuberc Lung Dis 19: 406412.
    [Google Scholar]
  11. Padmini N, Ajilda AAK, Sivakumar N, Selvakumar G, 2017. Extended spectrum β-lactamase producing Escherichia coli and Klebsiella pneumoniae: critical tools for antibiotic resistance pattern. J Basic Microbiol 57: 460470.
    [Google Scholar]
  12. Gröschel MI, Omansen TF, de Lange W, van der Werf TS, Lokate M, Bathoorn E, Akkerman OW, Stienstra Y, 2016. Case report: multidrug-resistant tuberculosis complicated by nosocomial infection with multidrug-resistant enterobacteriaceae. Am J Trop Med Hyg 94: 517518.
    [Google Scholar]
  13. NethMap, 2014. Consumption of Antimicrobial Agents and Antimicrobial Resistance Among Medically Important Bacteria in The Netherlands in 2013. Available at: https://www.wur.nl/upload_mm/1/a/1/0704c512-5b42-4cef-8c1b-60e9e3fb2a62_NethMap-MARAN2014.pdf. Accessed May 22, 2017.
  14. Glasner C et al., 2013. Carbapenemase-producing enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013. Euro Surveill 18: pii: 20525.
    [Google Scholar]
  15. Report S, 2015. Surveillance Report: Antimicrobial Resistance Surveillance in Europe 2014. Available at: http://ecdc.europa.eu/en/publications/publications/antimicrobial-resistance-europe-2014.pdf. Accessed June 8, 2017.
  16. Pournaras S, Protonotariou E, Voulgari E, Kristo I, Dimitroulia E, Vitti D, Tsalidou M, Maniatis AN, Tsakris A, Sofianou D, 2009. Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece. J Antimicrob Chemother 64: 348352.
    [Google Scholar]
  17. Giakkoupi P, Pappa O, Polemis M, Vatopoulos AC, Miriagou V, Zioga A, Papagiannitsis CC, Tzouvelekis LS, 2009. Emerging Klebsiella pneumoniae isolates coproducing KPC-2 and VIM-1 carbapenemases. Antimicrob Agents Chemother 53: 40484050.
    [Google Scholar]
  18. Voulgari E, Zarkotou O, Ranellou K, Karageorgopoulos DE, Vrioni G, Mamali V, Themeli-Digalaki K, Tsakris A, 2013. Outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae in Greece involving an ST11 clone. J Antimicrob Chemother 68: 8488.
    [Google Scholar]
  19. Tsakris A, Poulou A, Markou F, Pitiriga V, Piperaki ET, Kristo I, Pournaras S, 2011. Dissemination of clinical isolates of Klebsiella oxytoca harboring CMY-31, VIM-1, and a new OXY-2-type variant in the community. Antimicrob Agents Chemother 55: 31643168.
    [Google Scholar]
  20. Koutsogiannou M, Drougka E, Liakopoulos A, Jelastopulu E, Petinaki E, Anastassiou ED, Spiliopoulou I, Christofidou M, 2013. Spread of multidrug-resistant Pseudomonas aeruginosa clones in a university hospital. J Clin Microbiol 51: 665668.
    [Google Scholar]
  21. Tsakris A, Poulou A, Kristo I, Pittaras T, Spanakis N, Pournaras S, Markou F, 2009. Large dissemination of VIM-2-metallo-β-lactamase-producing Pseudomonas aeruginosa strains causing health care-associated community-onset infections. J Clin Microbiol 47: 35243529.
    [Google Scholar]
  22. Tsioutis C, Karageorgos S, Stratakou S, Bolikas E, Astrinaki E, Messaritaki A, Adami M, Georgiladakis A, Kassimati A, Gikas A, 2015. Four years of experience with carbapenem-resistant Gram-negative bacteria in two tertiary care hospitals in Crete, Greece. Antimicrob Resist Infect Control 4 (Suppl 1): P130.
    [Google Scholar]
  • Received : 09 Jul 2017
  • Accepted : 10 Nov 2017
  • Published online : 26 Dec 2017
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