Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study
Karthikeyan Kumarasamy,Mark Toleman,Timothy R. Walsh,Jay Bagaria,Fafhana Butt,Ravikumar Balakrishnan,Uma Chaudhary,Michel Doumith,Christian G. Giske,Seema Irfan,Padma Krishnan,Anil Kumar,Sunil Maharjan,Shazad Mushtaq,Tabassum Noorie,David L. Paterson,A. Pearson,Claire Perry,Rachel Pike,Bhargavi Rao,Ujjwayini Ray,Jayanta B. Sarma,Madhu Sharma,Elizabeth Sheridan,M A Thirunarayan,Jane F. Turton,Supriya Upadhyay,Marina Warner,William Welfare,David M. Livermore,Neil Woodford +30 more
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The prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK is investigated, and co-ordinated international surveillance is needed.Abstract:
Summary Background Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-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. Funding European Union, Wellcome Trust, and Wyeth.read more
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Nosocomial Outbreak of New Delhi Metallo-β-Lactamase-1-Producing Gram-Negative Bacteria in South Africa: A Case-Control Study
TL;DR: NDM-1 infection is associated with significant in-hospital mortality and risk factors for hospital-associated infection include the presence of co-morbid disease, mechanical ventilation and piperacillin/tazobactam exposure.
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Impact of anthropogenic activities on the dissemination of antibiotic resistance across ecological boundaries.
Vijay Tripathi,Eddie Cytryn +1 more
TL;DR: This review summarizes the current state of knowledge regarding antibiotic resistance in non-clinical environments, specifically focusing on the dissemination of antibiotic resistance across ecological boundaries and the contribution of this phenomenon to global antibiotic resistance.
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Diagnosis and antimicrobial treatment of invasive infections due to multidrug-resistant Enterobacteriaceae. Guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology.
Jesús Rodríguez-Baño,José Miguel Cisneros,Nazaret Cobos-Trigueros,Gema Fresco,Carolina Navarro-San Francisco,Carlota Gudiol,Juan Pablo Horcajada,Lorena López-Cerero,José Antonio Martínez,José Molina,Milagro Montero,José Ramón Paño-Pardo,Álvaro Pascual,Carmen Peña,Vicente Pintado,Pilar Retamar,María Tomás,Marcio Borges-Sa,José Garnacho-Montero,Germán Bou +19 more
TL;DR: Evidence-based recommendations are provided for the use of microbiological techniques for the detection of extended-spectrum β-lactamases and carbapenemases in Enterobacteriaceae, and for antibiotic therapy for invasive/severe infections caused by these organisms.
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The perils of medical tourism: NDM-1-positive Escherichia coli causing febrile neutropenia in a medical tourist
TL;DR: A case of NDM-1 infection in an immunocompromised foreign patient is described, and its implications are discussed.
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Molecular basis for the increased polymyxin susceptibility of Klebsiella pneumoniae strains with under-acylated lipid A
Tony Velkov,Rachel L. Soon,Pei L Chong,Johnny X. Huang,Mark E. Cooper,Mohammad Abul Kalam Azad,Mark Baker,Philip E. Thompson,Kade D. Roberts,Roger L. Nation,Abigail Clements,Richard A. Strugnell,Jian Li +12 more
TL;DR: Under-acylation appears to facilitate the integration of the N-terminal fatty-acyl chain of polymyxin into the OM resulting in an increased susceptibility to its antimicrobial activity/activities.
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