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The Public Health Agency of Canada (PHAC) has developed "Guidance: Infection Prevention and Control Measures for Healthcare Workers in All Healthcare Settings Carbapenem-resistant Gram-negative Bacilli" to provide instruction in the management of patients colonized or infected with carbapenem-resistant Gram-negative bacilli (CRGNB), including the New Delhi metallo beta-lactamase (NDM-1). This guidance is based on current, available scientific evidence and is subject to review and change as new information becomes available. It is not to be viewed as binding, but indicates the best practices to follow.
Gram-negative bacilli commonly encountered in healthcare settings include species such as Pseudomonas aeruginosa, Acinetobacter spp. and Stenotrophomonas maltophilia, and species belonging to the Enterobacteriaceae family, such as Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae. Recent events indicate an increasing occurrence of antimicrobial resistance in Gram-negative bacteria. The carbapenem group of antimicrobials is a safe and generally effective treatment for severe Gram-negative bacterial infections when resistance to other classes of antimicrobials is present. When resistance to carbapenems occurs, there are often few alternative treatments available.
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