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MCR-1 cases in Italy

MCR-1 or mobilised colistin resistance 1 to give it its full title is a resistance gene coded onto a transferable plasmid – meaning it can facilitate the transfer of colistin resistance between bacteria. MCR-1 is scary. Colistin is one of the “antibiotics of last resort” and the existence of a mechanism to potentially transmit resistance to bacteria already multi-drug resistant could lead to untreatable infections.

Clinicians in Italy have reported 3 cases of colistin resistant Escherichia coli in the same hospital between August 2016 and January 2017. Detailed in the April edition of Eurosurveillance, the three cases of bloodstream infection were identified as different strains and all showed the presence of the MCR-1 gene. The authors of the paper warn of the significance of finding 3 MCR-1 cases in the same hospital in 6 months and suggest that it indicates a widespread problem within Italy. They also postulate that the dissemination of MCR-1 in Italy could be seriously underestimated. 

As MCR-1 was first described in November 2015 – approximately 18 months ago – and we have multiple, distinct cases are being reported in a single hospital it is extremely troubling. Fortunately, for the patients involved in the cases described, the E.coli strains were susceptible to other classes of antibiotics and the bloodstream infections were resolved. However, as gene transmission and exchange continues, the likelihood of pan drug resistant bacteria is increasing.

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