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Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study.
Lancet Infect Dis. 2010 Sep; 10(9):597-602.LI

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.

Authors+Show Affiliations

Department of Microbiology, Dr ALM PG IBMS, University of Madras, Chennai, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20705517

Citation

Kumarasamy, Karthikeyan K., et al. "Emergence of a New Antibiotic Resistance Mechanism in India, Pakistan, and the UK: a Molecular, Biological, and Epidemiological Study." The Lancet. Infectious Diseases, vol. 10, no. 9, 2010, pp. 597-602.
Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010;10(9):597-602.
Kumarasamy, K. K., Toleman, M. A., Walsh, T. R., Bagaria, J., Butt, F., Balakrishnan, R., Chaudhary, U., Doumith, M., Giske, C. G., Irfan, S., Krishnan, P., Kumar, A. V., Maharjan, S., Mushtaq, S., Noorie, T., Paterson, D. L., Pearson, A., Perry, C., Pike, R., ... Woodford, N. (2010). Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. The Lancet. Infectious Diseases, 10(9), 597-602. https://doi.org/10.1016/S1473-3099(10)70143-2
Kumarasamy KK, et al. Emergence of a New Antibiotic Resistance Mechanism in India, Pakistan, and the UK: a Molecular, Biological, and Epidemiological Study. Lancet Infect Dis. 2010;10(9):597-602. PubMed PMID: 20705517.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. AU - Kumarasamy,Karthikeyan K, AU - Toleman,Mark A, AU - Walsh,Timothy R, AU - Bagaria,Jay, AU - Butt,Fafhana, AU - Balakrishnan,Ravikumar, AU - Chaudhary,Uma, AU - Doumith,Michel, AU - Giske,Christian G, AU - Irfan,Seema, AU - Krishnan,Padma, AU - Kumar,Anil V, AU - Maharjan,Sunil, AU - Mushtaq,Shazad, AU - Noorie,Tabassum, AU - Paterson,David L, AU - Pearson,Andrew, AU - Perry,Claire, AU - Pike,Rachel, AU - Rao,Bhargavi, AU - Ray,Ujjwayini, AU - Sarma,Jayanta B, AU - Sharma,Madhu, AU - Sheridan,Elizabeth, AU - Thirunarayan,Mandayam A, AU - Turton,Jane, AU - Upadhyay,Supriya, AU - Warner,Marina, AU - Welfare,William, AU - Livermore,David M, AU - Woodford,Neil, Y1 - 2010/08/10/ PY - 2010/8/14/entrez PY - 2010/8/14/pubmed PY - 2010/9/24/medline SP - 597 EP - 602 JF - The Lancet. Infectious diseases JO - Lancet Infect Dis VL - 10 IS - 9 N2 - 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. SN - 1474-4457 UR - https://www.unboundmedicine.com/medline/citation/20705517/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1473-3099(10)70143-2 DB - PRIME DP - Unbound Medicine ER -