TY - JOUR
T1 - Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK
T2 - 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
N1 - Funding Information:
Our work was funded by EU grant LSHM-CT-2005-018705 and Wellcome Trust grant 084627/Z/08 . We thank Amitabha Bhattacharjee (Assam University, Silchar, India), Malay R Sen (Banaras Hindu University, Varanasi, India), and Payal Deshpande, C Rodrigues, and A Shetty (Hinduja Hospital, Mumbai India) for providing NDM-1 positive strains.
PY - 2010/9
Y1 - 2010/9
N2 - 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 blaNDM-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.
AB - 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 blaNDM-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.
UR - http://www.scopus.com/inward/record.url?scp=77955917495&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(10)70143-2
DO - 10.1016/S1473-3099(10)70143-2
M3 - Article
C2 - 20705517
AN - SCOPUS:77955917495
SN - 1473-3099
VL - 10
SP - 597
EP - 602
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 9
ER -
