Single- and multiple-dose pharmacokinetics and total removal of colistin in a patient with acute kidney injury undergoing extended daily dialysis.

(poultry, pigs, cattle etc.) is high, there is still little evidence that ESBL producers are spreading mainly through the food chain. 4 Taking into account the paucity of reports of carbapenemase producers in animals, and the fact that carbapenems are not used in food-producing animals, the risk to public health remains marginal. Nowadays, the major threat related to the spread of carbape-nemase producers among humans is linked to a lack of hygiene, to contaminated drinking water and to poor control of antibiotic usage in some highly populated geographical areas. 5 As a consequence , some countries may become endemic not only for ESBL producers but also for carbapenemase producers. As examples, it is estimated that among isolates associated with intra-abdominal infections in India during 2008, 61% and 47% were ESBL-producing E. coli and K. pneumoniae, respectively. 6 In Pakistan, the faecal carriage of NDM-1-producing isolates among hospitalized patients was estimated at 15% –20%. 7 In a country such as Switzerland, where the rate of patient colonization with ESBL-producing Enterobacteriaceae at admission has been evaluated to be 4% – 5%, 8 while being 8.4% among the Swiss slaughter cattle population, 9 recent surveys have reported the lack of detection of carbapenemase-producing Enterobacteriaceae among farm animals and community patients. 10,11 The first case of colonization by a carbapenemase-producing S. enterica strain has recently been reported, being an OXA-48 producer recovered from a patient transferred from Libya to Switzerland. 12 Knowing that Libya is endemic for OXA-48-producing Enterobacteriaceae, 13 this case further highlights that the risk of acquisition of carbapenemase producers mainly comes from human endemic areas. Rapid identification of carbapenemase producers by using easy-to-handle and affordable techniques will contribute to the recognition of infected and colonized patients at an early stage. 14 This will allow the rapid implementation of isolation and cohorting strategies, and the improvement of antibiotic stew-ardship to prevent the development of outbreaks. It may also contribute to better identification of the possible dissemination of carbapenemase producers, not only within the human population but also from a human source to animals. References 1 Woodford N, Wareham DW, Guerra B et al. Carbapenemase-producing Enterobacteriaceae and non-Enterobacteriaceae from animals and the environment: an emerging public health risk of our own making? 2 Abraham S, Wong HS, Turnidge J et al. Carbapenemase-producing bacteria in companion animals: a public health concern on the horizon. 4 EFSA Panel on Biological Hazards (BIOHAZ). Scientific opinion on …