Hi, all.
The news media today are carrying
stories about newly-discovered drug-resistant gut bacteria that may
have originated in India. A gene called NDM-1 is being exchanged
between different species of bacteria, making them resistant to most
antibiotics. With all the gut problems PWMEs/PWCs already have, this
is not good news. I think this really emphasizes the importance of
considering non-pharmaceutical antimicrobials.
Best regards,
Rich
Lancet Infect Dis. 2010 Sep;10(9):597-602. Epub 2010 Aug 10.
Emergence of a new antibiotic resistance mechanism in India, Pakistan,
and the UK: a molecular, biological, and epidemiological study.
Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan
R, Chaudhary U, Doumith M, Giske CG, Irfan S, Krishnan P, Kumar AV,
Maharjan S, Mushtaq S, Noorie T, Paterson DL, Pearson A, Perry C, Pike
R, Rao B, Ray U, Sarma JB, Sharma M, Sheridan E, Thirunarayan MA,
Turton J, Upadhyay S, Warner M, Welfare W, Livermore DM, Woodford N.
Department of Microbiology, Dr ALM PG IBMS, University of Madras,
Chennai, India.
Abstract
BACKGROUND: Gram-negative Enterobacteriaceae with resistance to
carbapenem conferred by New Delhi metallo-beta-lactamase 1 (NDM-1) are
potentially a major global health problem. We investigated the
prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in
India, Pakistan, and the UK.
METHODS: Enterobacteriaceae isolates were studied from two major
centres in India--Chennai (south India), Haryana (north India)--and
those referred to the UK's national reference laboratory. Antibiotic
susceptibilities were assessed, and the presence of the carbapenem
resistance gene bla(NDM-1) was established by PCR. Isolates were typed
by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA.
Plasmids were analysed by S1 nuclease digestion and PCR typing. Case
data for UK patients were reviewed for evidence of travel and recent
admission to hospitals in India or Pakistan.
FINDINGS: We identified 44 isolates with NDM-1 in Chennai, 26 in
Haryana, 37 in the UK, and 73 in other sites in India and Pakistan.
NDM-1 was mostly found among Escherichia coli (36) and Klebsiella
pneumoniae (111), which were highly resistant to all antibiotics
except to tigecycline and colistin. K pneumoniae isolates from Haryana
were clonal but NDM-1 producers from the UK and Chennai were clonally
diverse. Most isolates carried the NDM-1 gene on plasmids: those from
UK and Chennai were readily transferable whereas those from Haryana
were not conjugative. Many of the UK NDM-1 positive patients had
travelled to India or Pakistan within the past year, or had links with
these countries.
INTERPRETATION: The potential of NDM-1 to be a worldwide public health
problem is great, and co-ordinated international surveillance is
needed.
PMID: 20705517 [PubMed - in process]
The news media today are carrying
stories about newly-discovered drug-resistant gut bacteria that may
have originated in India. A gene called NDM-1 is being exchanged
between different species of bacteria, making them resistant to most
antibiotics. With all the gut problems PWMEs/PWCs already have, this
is not good news. I think this really emphasizes the importance of
considering non-pharmaceutical antimicrobials.
Best regards,
Rich
Lancet Infect Dis. 2010 Sep;10(9):597-602. Epub 2010 Aug 10.
Emergence of a new antibiotic resistance mechanism in India, Pakistan,
and the UK: a molecular, biological, and epidemiological study.
Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan
R, Chaudhary U, Doumith M, Giske CG, Irfan S, Krishnan P, Kumar AV,
Maharjan S, Mushtaq S, Noorie T, Paterson DL, Pearson A, Perry C, Pike
R, Rao B, Ray U, Sarma JB, Sharma M, Sheridan E, Thirunarayan MA,
Turton J, Upadhyay S, Warner M, Welfare W, Livermore DM, Woodford N.
Department of Microbiology, Dr ALM PG IBMS, University of Madras,
Chennai, India.
Abstract
BACKGROUND: Gram-negative Enterobacteriaceae with resistance to
carbapenem conferred by New Delhi metallo-beta-lactamase 1 (NDM-1) are
potentially a major global health problem. We investigated the
prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in
India, Pakistan, and the UK.
METHODS: Enterobacteriaceae isolates were studied from two major
centres in India--Chennai (south India), Haryana (north India)--and
those referred to the UK's national reference laboratory. Antibiotic
susceptibilities were assessed, and the presence of the carbapenem
resistance gene bla(NDM-1) was established by PCR. Isolates were typed
by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA.
Plasmids were analysed by S1 nuclease digestion and PCR typing. Case
data for UK patients were reviewed for evidence of travel and recent
admission to hospitals in India or Pakistan.
FINDINGS: We identified 44 isolates with NDM-1 in Chennai, 26 in
Haryana, 37 in the UK, and 73 in other sites in India and Pakistan.
NDM-1 was mostly found among Escherichia coli (36) and Klebsiella
pneumoniae (111), which were highly resistant to all antibiotics
except to tigecycline and colistin. K pneumoniae isolates from Haryana
were clonal but NDM-1 producers from the UK and Chennai were clonally
diverse. Most isolates carried the NDM-1 gene on plasmids: those from
UK and Chennai were readily transferable whereas those from Haryana
were not conjugative. Many of the UK NDM-1 positive patients had
travelled to India or Pakistan within the past year, or had links with
these countries.
INTERPRETATION: The potential of NDM-1 to be a worldwide public health
problem is great, and co-ordinated international surveillance is
needed.
PMID: 20705517 [PubMed - in process]
