A Case of a Hepatectomy for Multiple Intrahepatic Cholelithiasis Caused by NDM-1-producing Escherichia Coli

Abstract

New Delhi metallo-β-lactamase-1 (NDM-1) induces resistance to several antibiotics, including carbapenems. NDM-1 is not limited to opportunistic pathogens ; in fact, it can be produced by commensal bacteria such as Escherichia coli and Klebsiella pneumoniae, thus posing a public-health concern. NDM-1-producing bacteria have been reported to be prevalent in regions surrounding India and have been detected in travelers. In Japan, NDM-1-producing E. coli was first detected in 2009 in a returnee from India. We performed a left hepatectomy on a Nepalese patient with multiple intrahepatic cholelithiasis. The patient developed an intra-abdominal abscess at the resection site postoperatively. The patient's bile was colonized by NDM-1-producing E. coli, which was the causative organism of the abscess. NDM-1-producing E. coli is multidrug resistant, and treatment of the patient was focused on drainage and irrigation, which resolved the abscess in approximately two months. Herein, we report the perioperative management of a rare case of intrahepatic cholelithiasis caused by NDM-1-producing E. coli.