Showing papers on "New Delhi metallo-beta-lactamase 1 published in 2010"

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

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.

Emergence of Metallo-β-Lactamase NDM-1-Producing Multidrug-Resistant Escherichia coli in Australia

Abstract: A multidrug-resistant Escherichia coli isolate recovered in Australia produced a carbapenem-hydrolyzing β-lactamase. Molecular investigations revealed the first identification of the blaNDM-1 metallo-β-lactamase gene in that country. In addition, this E. coli isolate expressed the extended-spectrum β-lactamase CTX-M-15, together with two 16S rRNA methylases, namely, ArmA and RmtB, conferring a high level of resistance to aminoglycosides.

Coexistence of blaOXA-23 with blaNDM-1 and armA in clinical isolates of Acinetobacter baumannii from India.

Abstract: Sir, The production of carbapenemases is the most common mechanism responsible for carbapenem resistance in Acinetobacter baumannii. They include metallo-b-lactamases (VIM, IMP and SIM types), which have been sporadically reported in some parts of the world, and acquired OXA-type carbapenemases which have been more frequently identified worldwide and are clustered in three major subfamilies (blaOXA-23, blaOXA-24 and blaOXA-58). 1 High levels of resistance to aminoglycosides due to the production of plasmid-encoded 16S rRNA methylase in Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp. have been documented since 2003. The present study was undertaken to determine the mechanism responsible for the carbapenem resistance. Three carbapenem-non-susceptible A. baumannii were isolated from patients in the intensive care unit of a tertiary care hospital in Chennai, India in April 2010. Species identification and antibiotic testing were carried out using an automated machine (VITEK-2). The MICs of carbapenems and aminoglycosides were determined using the CLSI agar dilution method, while tigecycline MICs were determined using the EUCAST broth microdilution method. All the isolates were resistant to all the b-lactams, aminoglycosides and quinolones, and were only susceptible to tigecycline and colistin. Double disc synergy test (DDST) and modified Hodge test (MHT) were used for detection of metallo-b-lactamases and other carbapenemases, respectively. PCR screening was performed for OXA-type carbapenemases (blaOXA-23, -24, -51 and -58-like) and the known metallo-b-lactamase genes. 3 – 5 All three isolates showed positivity for both DDST and MHT, and PCR yielded the products with expected sizes for blaOXA-51, 23-like and blaNDM-1 (Table 1). Sequencing of both blaOXA-23 and blaNDM-1 genes showed 100% identities with previously reported genes. In all three isolates, the blaOXA-23 gene was adjacent to insertion element ISAba1, which provides the promoter required for expression of linked resistance genes; blaOXA-51-like genes were also found in all of the isolates, but were not activated by ISAba1. Conjugation experiments using Escherichia coli J53 as the recipient were unsuccessful. Plasmids of Enterobacteriaceae were not detected among A. baumannii by PCR-based replicon typing. Susceptibility testing showed increased MICs of carbapenems and an unusual phenotype of broad-spectrum high-level resistance to aminoglycosides, including amikacin, gentamicin, netilmicin and tobramycin (MICs.256 mg/L), with susceptibility to tigecycline (MIC1⁄40.5–1 mg/L). PCR screening was performed for 16S rRNA methylase-encoding genes (armA, rmtA, rmtB, rmtC, rmtD and npmA). – 9 All three isolates showed positivity for the armA gene (Table 1). NDM-1 metallo-b-lactamase-mediated resistance to carbapenems in Enterobacteriaceae has been found in many parts of India. However, to our knowledge, this is the first

New Delhi Metallo-beta lactamase (NDM-1) in Enterobacteriaceae: treatment options with carbapenems compromised.

Abstract: Background: Carbapenems are among the few useful antibiotics against multidrug resistant gram negative bacteria particularly those with extended spectrum beta lactamase. However resistance to carbapenems occurs and is mediated by mechanisms like loss of outer membrane proteins and production of beta lactamase that is capable of hydrolyzing carbapenems. An alert issued in the UK in 2009 warned of an increasing number of carbapenem resistant Enterobacteriaceae strains identified in UK hospital patients. Many of them were recently hospitalized in India and Pakistan and had new type of metallo beta lactamase designated as New Delhi Metallo-1 (NDM-1). Objective: To assess the production of NDM-1 type Metallo beta lactamase enzyme in Enterobacteriaceae at a tertiary care centre in Mumbai. Materials and Methods: Consecutive carbapenem resistant Enterobacteriaceae isolates were collected from August 2009 to November 2009. Susceptibility testing for carbapenems was performed by the disc diffusion method. Carbapenemase production was confirmed by Modified Hodge test. These strains were then subjected to single target PCR. A 475bp product was amplified by the NDM primers and visualized on 3% agarose gel. Results and Conclusions: Modified Hodge test was positive for all carbapenem resistant isolates. Of 24 carbapenem resistant Enterobacteriaceae 22 were NDM producers while 2 were NDM non producers. Amongst the 22 NDM producing organisms 10 were Klebsiella spp, 9 were Escherichia coli, 2 were Enterobacter spp and 1was Morganella morganii. This high number in a relatively short span is a worrisome trend that compromises the treatment options with the carbapenems.

New Delhi metallo-beta-lactamase 1-producing Enterobacteriaceae: emergence and response in Europe.

Abstract: Acquired carbapenemases confer extensive antibiotic resistance to Enterobacteriaceae and represent a public health threat. A novel acquired carbapenemase, New Delhi metallo-beta-lactamase 1 (NDM-1), has recently been described in the United Kingdom and Sweden, mostly in patients who had received care on the Indian subcontinent. We conducted a survey among 29 European countries (the European Union Member States, Iceland and Norway) to gather information on the spread of NDM-1-producing Enterobacteriaceae in Europe, on public health responses and on available national guidance on detection, surveillance and control. A total of 77 cases were reported from 13 countries from 2008 to 2010. Klebsiella pneumoniae was the most frequently reported species with 54%. Among 55 cases with recorded travel history, 31 had previously travelled or been admitted to a hospital in India or Pakistan and five had been hospitalised in the Balkan region. Possible nosocomial acquisition accounted for 13 of 77 cases. National guidance on NDM-1 detection was available in 14 countries and on NDM-1 control in 11 countries. In conclusion, NDM-1 is spreading across Europe, where it is frequently linked to a history of healthcare abroad, but also to emerging nosocomial transmission. National guidance in response to the threat of carbapenemase-producing Enterobacteriaceae is available in approximately half of the surveyed European countries. Surveillance of carbapenemase- producing Enterobacteriaceae must be enhanced in Europe and effective control measures identified and implemented.

Global spread of New Delhi metallo-β-lactamase 1

Abstract: Karthikeyan Kumarasamy and colleagues express concern about the emergence of New Delhi metallo-βlactamase (NDM-1) in enterobacteria in India, Pakistan, and the UK. One of the fi rst acquired metallo-βlactamase-producing enterobacteria reported was an IMP-1-producing Klebsiella pneumoniae isolated in Singapore in 1996. Since then we have undertaken hospital surveillance for carbapenem-resistant enterobacteria. Until 2009, the only other metallo-β-lactamase enterobacteria we isolated was another unrelated IMP-1-producing K pneumoniae in 2004. In early 2010, we isolated two K pneumoniae with a high level of resistance (determined by Etest; bioMerieux, Marcy l’Etoile, France) to many antibiotics including to carbapenems (table). The fi rst—DU1301/10—was from the urine of a patient who had just returned from a 5-month stay in India where he had an indwelling catheter inserted. The second isolate, DU7433/10, was from THK, CTK, and TYK did the experimental work to identify the β-lactamase genes, and did the typing studies. LW, YLL, HNL, and LCL managed and provided background information about the two cases. All authors were involved in writing the letter. We declare that we have no confl icts of interest.

Correct understanding of superbugs with New Delhi metallo-beta-lactamase-1

Abstract: The term "superbugs" refers to microbes with resistance to almost all antibiotics specifically recommended for the treatment. The superbugs disseminating worldwide included methicillinresistant Staphylococcus aureus ; vancomycin-resistant Staphylococcus aureus ; vancomycin-resistant Enterococcus ;carbapenem-resistant Gram-negative bacillus. Due to abuse of antibiotics, novel "superbug"emerged gradually, which demands optimizing antibiotic use, reinforcing surveillance of "superbugs" as well as nosocomial infection control. Key words: beta-Lactamases; Drug resistance,bacterial