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Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

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TLDR
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.

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Bacteriophages as twenty-first century antibacterial tools for food and medicine.

TL;DR: Bacteriophages have co-evolved with bacteria for billions of years and retain the ability to infect bacteria efficiently, and are undoubtedly one of the best potential sources of new solutions for the management of undesirable bacteria.
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Emergence of New Delhi metallo-β-lactamase type 1-producing Enterobacteriaceae and non-Enterobacteriaceae: global case detection and bacterial surveillance

TL;DR: A systematic review of the literature was conducted to summarize the descriptive and molecular epidemiology of human cases and surveillance reports with New Delhi metallo-β-lactamase type 1 (NDM-1)-producing bacteria reported worldwide from January 2008 through July 6, 2011, suggesting a global distribution of NDM-1-producing Enterobacteriaceae and non-Enterobacteriaiaceae.
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Resistance surveillance program report for selected European nations (2011).

TL;DR: European surveillance sampling demonstrates a wide array of resistant isolates, less prevalent among Gram-positive cocci that remain inhibited by several available agents, however, beta-lactamase-mediated mechanisms have spread widely among gram-negative bacilli, especially across the Eastern and Southern European nations.
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SMB-1, a Novel Subclass B3 Metallo-β-Lactamase, Associated with ISCR1 and a Class 1 Integron, from a Carbapenem-Resistant Serratia marcescens Clinical Isolate

TL;DR: The introduction of blaSMB-1 into Escherichia coli conferred resistance to a variety of β-lactam antibiotics, penicillins, cephalosporins, and carbapenems, but not aztreonam, a resistance pattern consistent with those of other MBLs.
References
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Journal ArticleDOI

Characterization of a New Metallo-β-Lactamase Gene, blaNDM-1, and a Novel Erythromycin Esterase Gene Carried on a Unique Genetic Structure in Klebsiella pneumoniae Sequence Type 14 from India

TL;DR: A Swedish patient of Indian origin traveled to New Delhi, India, and acquired a urinary tract infection caused by a carbapenem-resistant Klebsiella pneumoniae strain that typed to the sequence type 14 complex, showing broad resistance carried on these plasmids.
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The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria

TL;DR: In this article, the authors reported that the detection of Klebsiella pneumoniae carbapenemases (KPC) producing bacteria may be difficult based on routine antibiotic susceptibility testing.
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Resistance Plasmid Families in Enterobacteriaceae

TL;DR: Bacteria carry extrachromosomal, self-replicating genetic elements called plasmids, which do not carry genes essential for the growth of host cells under nonstressed conditions.
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The CTX-M β-lactamase pandemic

TL;DR: In the past decade CTX-M enzymes have become the most prevalent extended-spectrum beta-lactamases, both in nosocomial and in community settings, and dissemination has been associated with different clones or epidemic clones associated with specific enzymes such as CTx-M-15.
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