In March 2013, providers at an Illinois hospital were concerned. A patient with no history of foreign travel tested positive for a rare form of Escherichia coli producing New Delhi metallo-beta-lactamase (NDM), often resistant to antibiotics. In the next five months, six more patients tested positive for the same bacteria.
Working quickly, investigators realized that many of the initial patients had undergone endoscopic retrograde cholangiopancreatography (ERCP). Reviewing the records, they saw