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The recent emergence of carbapenem-resistant Enterobacteriaceae (CRE) has caused great concern worldwide. Perhaps even more worrisome is the report of an outbreak of plasmid-mediated CRE infections.
When two cases of infection caused by two different strains of carbapenem-resistant Klebsiella were identified in August 2007 at the University of Virginia Health System, the institution began screening all extended-spectrum β-lactamase–producing Enterobacteriaceae for carbapenemase production. During the next 8 months, 16 CRE strains representing 4 genera and 6 species were identified from 14 patients. The affected patients were located throughout the institution and had serious infections (all-cause 28-day mortality, 50%) that were hospital acq…