In March 2008, a 91-year-old man with dialysis-dependent end-stage renal disease, congestive heart failure, anemia, and peptic ulcer disease was admitted to a hospital in Tel Aviv, Israel. Following amputation of the left leg below the knee due to an infected heel wound, the patient developed sepsis. The patient was treated with a variety of antibiotics, including ertapenem, a carbapenem drug. During treatment, an acute inflammation of the gallbladder developed, so the patient had a surgical incision made in his gallbladder to help drain the infection. During his hospital stay, the patient was screened for carbapenem-resistant Enterobacteriacae (CRE) as part of the hospital's routine infection control program aimed at limiting the spread of these often antibiotic-resistant organisms. As such, CRE is an important health challenge in healthcare settings. Carbapenems are a class of antibiotics, similar to penicillins. The Enterobacteriacae are a family of Gram negative rods. Many members of this family are found as part of the normal human gut flora. This includes Escherichia coli, which is a very common part of the human flora, and Klebsiella pneumoniae, which is much less common. Klebsiella pneumoniae, is most often found in individuals with weakened immune systems. Two rectal swabs were collected one week apart for analysis by the hospital's clinical microbiology lab. The first swab specimen was negative for CRE by culture. However, the second swab specimen grew colonies (see figure below). Microscopy identified small, rods, which on further analysis were shown to be facultatively anaerobic and resistant to carbapenem, as well as all cephalosporin and monobactam antibiotics (both of which are beta-lactam type antibiotics). Identification was made as a carbapenem-resistant Klebsiella pneumoniae (CRKP) strain. Alarm was raised as CRKP is associated with increased mortality, particularly in patients with prolonged hospitalization. An aggressive infection control strategy was instituted. Two weeks later, a carbapenem-resistant E. coli strain was recovered from the patient's gallbladder drainage. Further infection control strategies were instituted in the hospital. From the figure, what is the Gram stain reaction for the small rods? 1. Gram-positive 2. Gram-negative 3. Acid fast negative 4. Impossible to determine 5. Acid fast positive
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In March 2008, a 91-year-old man with dialysis-dependent end-stage renal disease, congestive heart failure, anemia, and peptic ulcer disease was admitted to a hospital in Tel Aviv, Israel. Following amputation of the left leg below the knee due to an infected heel wound, the patient developed sepsis. The patient was treated with a variety of antibiotics, including ertapenem, a carbapenem drug. During treatment, an acute inflammation of the gallbladder developed, so the patient had a surgical incision made in his gallbladder to help drain the infection. During his hospital stay, the patient was screened for carbapenem-resistant Enterobacteriacae (CRE) as part of the hospital's routine infection control program aimed at limiting the spread of these often antibiotic-resistant organisms. As such, CRE is an important health challenge in healthcare settings. Carbapenems are a class of antibiotics, similar to penicillins. The Enterobacteriacae are a family of Gram negative rods. Many members of this family are found as part of the normal human gut flora. This includes Escherichia coli, which is a very common part of the human flora, and Klebsiella pneumoniae, which is much less common. Klebsiella pneumoniae, is most often found in individuals with weakened immune systems. Two rectal swabs were collected one week apart for analysis by the hospital's clinical Alarm was raised as CRKP is associated with increased mortality, particularly in patients with prolonged hospitalization. An aggressive infection control strategy was instituted. Two weeks later, a carbapenem-resistant E. coli strain was recovered from the patient's gallbladder drainage. Further infection control strategies were instituted in the hospital. From the figure, what is the
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