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LAC DPH Health Advisory
First mcr-1 Producing Bacteria Identified in
a Los Angeles County Resident
January 31, 2017 
This message is intended for all health care providers, particularly hospital-based providers.
Please distribute as appropriate.
Key Message
  • An mcr-1 producing bacterial isolate has been identified in a Los Angeles County (LAC) resident, the first reported case in California. The mcr-1 gene confers resistance to the antibiotic colistin, one of few “last resort” antibiotics used to treat infections caused by certain multi-drug resistant organisms.
  • Hospital-based providers should follow LAC Department of Public Health (DPH) recommendations regarding infection control, testing, and reporting for patients with suspected and confirmed mcr-1 organisms.
Situation
Los Angeles County has identified the first patient in California with an mcr-1 producing bacterial isolate. The E. coli infection was most likely acquired during international travel and no evidence of spread in the local health care community has been identified.  Mcr-1 producing bacteria were first identified in the United States in a Pennsylvania patient in May 2016; since then, the mcr-1 gene has been reported in human specimens from five additional states and in animal specimens from two states.  The appearance of mcr-1 in Los Angeles serves as a reminder of the importance of infection control measures and antibiotic stewardship. 
Actions Requested of Providers
√ Infection Prevention: Healthcare providers should follow Standard and Contact Precautions for any patient who is suspected to be colonized or infected with mcr-1 positive organisms based on colistin resistance, pending mcr-1 confirmation, OR any patient confirmed to be colonized or infected with mcr-1 positive organisms
√ Laboratory Testing: Isolates with a minimum inhibitory concentration (MIC) to colistin of 4 µg/ml or higher should be tested for the presence of mcr-1. If hospital mcr-1 confirmatory testing cannot be performed, contact LAC DPH Acute Communicable Disease Control (ACDC) at 213-240-7941 to arrange for the isolates to be tested at the LAC Public Health Laboratory.
√ Reporting: All mcr-1 positive isolates identified in LAC residents and at LAC health care facilities must be reported within one working day by calling ACDC at 213-240-7941. 
For Questions and Reporting:
Los Angeles County DPH Acute Communicable Disease Control Program:
•Weekdays 8:30am-5pm: call 213-240-7941 
•After hours: call 213-974-1234 and ask for the physician on call.
 
For Residents of Long Beach and Pasadena:
Long Beach Health and Human Services:
•Weekdays 8am-5pm: call 562-570-4302
•After hours: call 562-435-6711 and ask for Communicable Disease Officer.
Pasadena Public Health Department: 
•Weekdays: call the Communicable Disease Control Program 626-744-6089
•After hours: call 626-744-6043.
Resources
This Health Advisory was sent by Dr. Benjamin Schwartz, Interim Director, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health.
To see this and other LAHAN communications, please visit: publichealth.lacounty.gov/lahan
If this message was forwarded to you, please join LAHAN here.  
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