Correct!
5. All of the above

CTX-M comprises a set of 160 related genes that make up the most common type of ESBL in the world, rapidly increasing now in the United States (4). The CTX-M gene naturally resides in the chromosomes of Kluyvera species – non-pathogenic flora of the human gastrointestinal tract that can however transmit the CTX-M gene to pathogenic Enterobacteriaceae via plasmids.
The NDM (New Delhi Metallo-beta-lactamase) gene represents a mechanism of carbapenem resistance (5). The resistance is due to a plasmid-mediated carbapenemase that typically also confers resistance to newer beta-lactamase inhibitor combination antibiotics, which are typically efficacious against other mechanisms of carbapenem resistance.
Within 36 hours, the patient was awake and alert, epinephrine, phenylephrine and vasopressin were discontinued, and norepinephrine reduced to 5 mcg/min. The vasopressor was eventually weaned and the patient was transferred to the general medical ward. Eravacycline was later added to his antibiotic regime once further susceptibility testing resulted. The patient survived a one-month hospitalization and was discharged back to his skilled nursing facility in poor condition. He continued to require recurrent readmissions and died 4 months later with another episode of refractory septic shock caused by the same multi-drug resistant Klebsiella organism (5).

References

  1. Esayag Y, Nikitin I, Bar-Ziv J, Cytter R, Hadas-Halpern I, Zalut T, Yinnon AM. Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. Am J Med. 2010 Jan;123(1):88.e1-5. [CrossRef] [PubMed]
  2. Gilhus NE. Myasthenia Gravis. N Engl J Med. 2016 Dec 29;375(26):2570-2581. [CrossRef] [PubMed]
  3. Rodrigues D, Baldissera GS, Mathos D, Sartori A, Zavascki AP, Rigatto MH. Amikacin for the treatment of carbapenem-resistant Klebsiella pneumoniae infections: clinical efficacy and toxicity. Braz J Microbiol. 2021 Dec;52(4):1913-1919. [CrossRef] [PubMed]
  4. Wang G, Huang T, Surendraiah PK, Wang K, Komal R, Zhuge J, Chern CR, Kryszuk AA, King C, Wormser GP. CTX-M β-lactamase-producing Klebsiella pneumoniae in suburban New York City, New York, USA. Emerg Infect Dis. 2013 Nov;19(11):1803-10. [CrossRef] [PubMed]
  5. Chen L, Todd R, Kiehlbauch J, Walters M, Kallen A. Notes from the Field: Pan-Resistant New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae - Washoe County, Nevada, 2016. MMWR Morb Mortal Wkly Rep. 2017 Jan 13;66(1):33. [CrossRef] [PubMed]

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