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Multidrug-Resistant Tuberculosis Complicated by Nosocomial Infection with Multidrug-Resistant Enterobacteriaceae

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  • Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Treatment of mycobacterial diseases such as tuberculosis (TB) entails long and intense antimicrobial therapy. TB patients are at risk of coinfection with other multidrug-resistant bacteria, such as those from Enterobacteriaceae family, because of antimicrobial selection pressure and nosocomial transmission during prolonged hospital admission. Here, we report on two patients treated for multidrug-resistant TB, who developed severe sepsis due to an extended spectrum β-lactamase producing organism. Diagnostic culture identified the venous access port as source, and upon surgical removal and antimicrobial therapy rapid clinical improvement was achieved. Increased awareness and knowledge on the prevalence of multi-resistant Enterobacteriaceae is needed, notably in TB centers, to provide a safe hospital environment to our patients.

Author Notes

* Address correspondence to Matthias I. Gröschel, Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. E-mail: m.i.p.groschel@umcg.nl

Authors' addresses: Matthias I. Gröschel, Wiel de Lange, Tjip S. van der Werf, and Onno W. Akkerman, Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, Groningen, The Netherlands, E-mails: m.i.p.groschel@umcg.nl, w.c.m.de.lange@umcg.nl, t.s.van.der.werf@umcg.nl, and o.w.akkerman@umcg.nl. Till F. Omansen and Ymkje Stienstra, Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, Groningen, The Netherlands, E-mails: t.f.omansen@umcg.nl and y.stienstra@umcg.nl. Mariëtte Lokate and Erik Bathoorn, Department of Medical Microbiology, University Medical Center Groningen, Groningen, The Netherlands, E-mails: m.lokate@umcg.nl and d.bathoorn@umcg.nl.

Reprint requests: Ymkje Stienstra, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30 001, 9700 RB Groningen, The Netherlands, E-mail: y.stienstra@umcg.nl, Tel: +31 (0) 503619320, Fax: +31 (0) 503619320.

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