{"id":10337,"date":"2025-03-01T14:07:41","date_gmt":"2025-03-01T19:07:41","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan362\/"},"modified":"2025-03-02T00:53:21","modified_gmt":"2025-03-02T05:53:21","slug":"dhan362","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan362\/","title":{"rendered":"php\/alerts\/dhan362 ~  Division of Public Health &#8212; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan362.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->362 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->June 14, 2016 3:50 pm <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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The\n\n\n  <em>mcr-1<\/em> gene makes bacteria resistant to the antibiotic colistin, which is used as a last-resort drug to treat patients with\n\n\n  infections caused by multidrug-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). The <em>mcr-1<\/em> gene\n\n\n  exists on a plasmid, a small piece of DNA that is capable of moving from one bacterium to another, potentially spreading antibiotic\n\n\n  resistance to other bacterial species. CDC is issuing this HAN notice as a reminder to U.S. healthcare facilities about recommendations\n\n\n  to prevent antibiotic resistant infections and alert them to additional recommendations for detecting and reporting bacteria with the\n\n\n  <em>mcr-1<\/em> gene.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Background\n\n\n<\/h3>\n\n\n<p>\n\n\n  In November 2015, a report from China first described plasmid-mediated colistin-resistance caused by the <em>mcr-1<\/em> gene. Following\n\n\n  that report, retrospective investigations of historical isolates from outside the United States have identified the rare occurrence of\n\n\n  <em>mcr-1<\/em> in Enterobacteriaceae from the 1980s. Bacteria with this resistance mechanism have now been identified from humans, food,\n\n\n  environmental samples, and food animals in at least 20 countries around the world. Most reports to date have identified the\n\n\n  <em>mcr-1<\/em> gene in <em>E. coli<\/em>, but it has also been reported from <em>Salmonella<\/em> species, <em>Shigella sonnei<\/em>, and\n\n\n  <em>Klebsiella pneumoniae<\/em>.\n\n\n<\/p>\n\n\n<p>\n\n\n  Three <em>mcr-1<\/em> producing <em>E. coli<\/em> have been identified in the United States as of June 7, 2016: one in a clinical specimen\n\n\n  from a person in Pennsylvania and two from intestinal samples from pigs. The <em>E. coli<\/em> isolate from the patient was also resistant\n\n\n  to antibiotics in at least five additional antibiotic classes, including cephalosporins, fluoroquinolones, sulfonamides, aminoglycosides,\n\n\n  and tetracyclines. The sample from one pig also was resistant to other antibiotics, including ampicillin, streptomycin, sulfisoxazole,\n\n\n  and tetracycline. No additional resistance was found in the isolate from the second pig. The presence of the <em>mcr-1<\/em> gene on a\n\n\n  plasmid means that colistin resistance can be shared with other more resistant bacteria such as CRE, raising the possibility that\n\n\n  untreatable bacteria could develop. A rapid public health response is underway to identify and contain any potential spread from the\n\n\n  patient. CDC laboratories have developed protocols for testing microorganisms for the <em>mcr-1<\/em> gene and are performing screening\n\n\n  tests to see if people in contact with the patient with <em>mcr-1<\/em> might be colonized with this organism. CDC is increasing its\n\n\n  surveillance of human samples from U.S. healthcare settings. CDC\u2019s National Antimicrobial Resistance Monitoring System, in\n\n\n  collaboration with the Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA), will continue to look for\n\n\n  <em>mcr-1<\/em> mediated colistin resistance in enteric bacteria from humans, retail meat, and food animals.\n\n\n<\/p>\n\n\n<h3>\n\n\n  Recommendations\n\n\n<\/h3>\n\n\n<p>\n\n\n  Given the discovery of <em>mcr-1<\/em> in a person in Pennsylvania, CDC reiterates the importance of measures to prevent transmission of\n\n\n  antibiotic resistant bacteria, including those resistant to colistin or carrying the <em>mcr-1<\/em> gene. CDC recommends the following:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>\n\n\n    <strong>Infection Prevention:<\/strong> Healthcare providers should follow <a href=\"http:\/\/www.cdc.gov\/hicpac\/2007IP\/2007ip_part3.html\">Standard and Contact Precautions<\/a> (<a href=\"http:\/\/www.cdc.gov\/hicpac\/2007IP\/2007ip_part3.html\">http:\/\/www.cdc.gov\/hicpac\/2007IP\/2007ip_part3.html<\/a>) for any patients colonized\n\n\n    or infected with antibiotic resistant bacteria, including patients who are found to have <em>mcr-1<\/em> mediated resistant organisms.\n\n\n    Healthcare facilities should follow manufacturers\u2019 instructions for device cleaning and reprocessing.\n\n\n  <\/li>\n\n\n  <li>\n\n\n    <strong>Laboratory Testing:<\/strong> If laboratories are testing to determine whether colistin can be used clinically,\n\n\n    Enterobacteriaceae isolates with a minimum inhibitory concentration (MIC) to colistin of 4 \u00b5g\/ml or higher should be tested for\n\n\n    confirmation and the presence of <em>mcr-1<\/em>. Thus far, all microorganisms that have contained the <em>mcr-1<\/em> gene can safely be\n\n\n    tested in a biosafety level-2 (BSL-2) laboratory. Isolates should be sent to CDC for confirmatory testing via the state or local public\n\n\n    health department, per the <a href=\"http:\/\/www.cdc.gov\/laboratory\/specimen-submission\/detail.html?CDCTestCode=CDC-10223\">CDC test\n\n\n    directory<\/a> (<a href=\"http:\/\/www.cdc.gov\/laboratory\/specimen-submission\/detail.html?CDCTestCode=CDC-10223\">http:\/\/www.cdc.gov\/laboratory\/specimen-submission\/detail.html?CDCTestCode=CDC-10223<\/a>),\n\n\n    if local testing is not available. The results and test method that were used for initial colistin testing should be included with any\n\n\n    isolates submitted for confirmatory testing. CDC laboratories are in the process of validating a rapid polymerase chain reaction (PCR)\n\n\n    test to detect <em>mcr-1<\/em> in bacteria with elevated colistin MICs. It is not necessary to test Enterobacteriaceae with intrinsic\n\n\n    colisitin resistance (e.g., <em>Proteus<\/em>, <em>Providencia<\/em>, <em>Morganella<\/em>, and <em>Serratia<\/em> species). Additionally,\n\n\n    since <em>Enterobacter<\/em> species often have MICs of >=2 mcg\/ml to colisitin, they should be sent for <em>mcr-1<\/em> testing only\n\n\n    if other risk factors exist, such as a recent history of travel outside the United States to a <a href=\"http:\/\/www.eurosurveillance.org\/ViewArticle.aspx?ArticleId=21403\">country where <em>mcr-1<\/em> has been found to be more common<\/a>\n\n\n    (<a href=\"http:\/\/www.eurosurveillance.org\/ViewArticle.aspx?ArticleId=21403\">http:\/\/www.eurosurveillance.org\/ViewArticle.aspx?ArticleId=21403<\/a>).\n\n\n  <\/li>\n\n\n  <li>\n\n\n    <strong>Validation of Laboratory Testing:<\/strong> CDC is making test-bacteria with elevated colistin MICs, available to laboratories,\n\n\n    researchers, and others through the <a href=\"http:\/\/www.cdc.gov\/drugresistance\/resistance-bank\/\">FDA-CDC Antimicrobial Resistance\n\n\n    Bacteria Isolate Bank<\/a> (<a href=\"http:\/\/www.cdc.gov\/drugresistance\/resistance-bank\/\">http:\/\/www.cdc.gov\/drugresistance\/resistance-bank\/<\/a>) for use in validation of\n\n\n    colistin-resistance testing in U.S. clinical laboratories.\n\n\n  <\/li>\n\n\n  <li>\n\n\n    <strong>Environmental Cleaning<\/strong>: Healthcare facilities should ensure rooms where patients with antibiotic-resistant infections\n\n\n    have been placed receive thorough daily and terminal cleaning.\n\n\n  <\/li>\n\n\n  <li>\n\n\n    <strong>Reporting to Public Health:<\/strong> Healthcare facilities and laboratories should adhere to local reporting requirements for\n\n\n    all antibiotic resistant infections. If Enterobacteriaceae with <em>mcr-1<\/em> are identified from patients, healthcare facilities and\n\n\n    laboratories should notify local or state public health authorities as quickly as possible, and inform clinicians caring for the\n\n\n    patient and responsible infection prevention staff.\n\n\n  <\/li>\n\n\n  <li>\n\n\n    <strong>Preparing food safely:<\/strong> Cook all meat, poultry, and fish to its <a href=\"http:\/\/www.foodsafety.gov\/keep\/charts\/mintemp.html\">proper internal temperature to kill bacteria<\/a> (<a href=\"http:\/\/www.foodsafety.gov\/keep\/charts\/mintemp.html\">http:\/\/www.foodsafety.gov\/keep\/charts\/mintemp.html<\/a>), viruses, and other\n\n\n    foodborne pathogens, regardless of antibiotic resistance.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<h3>\n\n\n  For More Information\n\n\n<\/h3>\n\n\n<ol>\n\n\n  <li>CDC Facility Guidance for Control of CRE: November 2015<br>\n\n\n    Update: <a href=\"http:\/\/www.cdc.gov\/hai\/pdfs\/cre\/CRE-guidance-508.pdf\">http:\/\/www.cdc.gov\/hai\/pdfs\/cre\/CRE-guidance-508.pdf<\/a>\n\n\n  <\/li>\n\n\n  <li>Responding to new Forms of Antibiotic Resistance:<br>\n\n\n    <a href=\"http:\/\/www.cdc.gov\/hai\/pdfs\/toolkits\/Responding-to-New-Forms-of-Antibiotic-Resistance.pdf\">http:\/\/www.cdc.gov\/hai\/pdfs\/toolkits\/Responding-to-New-Forms-of-Antibiotic-Resistance.pdf<\/a>\n\n\n  <\/li>\n\n\n  <li>Biosafety in Microbiological and Biomedical Laboratories, 5<sup>th<\/sup> Edition:<br>\n\n\n    <a href=\"http:\/\/www.cdc.gov\/biosafety\/publications\/bmbl5\/BMBL.pdf\">http:\/\/www.cdc.gov\/biosafety\/publications\/bmbl5\/BMBL.pdf<\/a>\n\n\n  <\/li>\n\n\n  <li>CDC Vital Signs Report: Making Health Care Safer, Protect Patients from Antibiotic Resistance:<br>\n\n\n    <a href=\"http:\/\/www.cdc.gov\/vitalsigns\/protect-patients\/index.html\">http:\/\/www.cdc.gov\/vitalsigns\/protect-patients\/index.html<\/a>\n\n\n  <\/li>\n\n\n<\/ol>\n\n\n<p class=\"text-center\">\n\n\n  <em>The Centers for Disease Control and Prevention (CDC) protects people&#8217;s health and safety by preventing and controlling diseases and\n\n\n  injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through\n\n\n  strong partnerships with local, national, and international organizations.<\/em>\n\n\n<\/p>\n\n\n<p>\n\n\n  ************************************\n\n\n<\/p>\n\n\n<p>\n\n\n  You are receiving this email because you are a registered member of the Delaware Health Alert Network. If you are not a member and would\n\n\n  like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a>\n\n\n<\/p><br>\n\n\n<br>\n\n\n<p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  A free copy of Adobe Acrobat Reader can be downloaded directly from <a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\">Adobe <\/a>. If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p>\n\n\n\n<!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #362 June 14, 2016 3:50 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10337","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10337","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10337"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10337\/revisions"}],"predecessor-version":[{"id":11513,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10337\/revisions\/11513"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10337"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}