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

Kumarasamy, Karthikeyan K., Toleman, Mark A., Walsh, Timothy R., Bagaria, Jay, Butt, Fafhana, Balakrishnan, Ravikumar, Chaudhary, Uma, Doumith, Michel, Giske, Christian G., Irfan, Seema, Krishnan, Padma, Kumar, Anil V., Maharjan, Sunil, Mushtaq, Shazad, Noorie, Tabassum, Paterson, David L., Pearson, Andrew, Perry, Claire, Pike, Rachel, Rao, Bhargavi, Ray, Ujjwayini, Sarma, Jayanta B., Sharma, Madhu, Sheridan, Elizabeth, Thirunarayan, Mandayam A., Turton, Jane, Upadhyay, Supriya, Warner, Marina, Welfare, William, Livermore, David M. and Woodford, Neil (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. doi:10.1016/S1473-3099(10)70143-2


Author Kumarasamy, Karthikeyan K.
Toleman, Mark A.
Walsh, Timothy R.
Bagaria, Jay
Butt, Fafhana
Balakrishnan, Ravikumar
Chaudhary, Uma
Doumith, Michel
Giske, Christian G.
Irfan, Seema
Krishnan, Padma
Kumar, Anil V.
Maharjan, Sunil
Mushtaq, Shazad
Noorie, Tabassum
Paterson, David L.
Pearson, Andrew
Perry, Claire
Pike, Rachel
Rao, Bhargavi
Ray, Ujjwayini
Sarma, Jayanta B.
Sharma, Madhu
Sheridan, Elizabeth
Thirunarayan, Mandayam A.
Turton, Jane
Upadhyay, Supriya
Warner, Marina
Welfare, William
Livermore, David M.
Woodford, Neil
Title Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study
Journal name The Lancet Infectious Diseases   Check publisher's open access policy
ISSN 1473-3099
Publication date 2010-09
Sub-type Article (original research)
DOI 10.1016/S1473-3099(10)70143-2
Volume 10
Issue 9
Start page 597
End page 602
Total pages 6
Place of publication United Kingdom
Publisher The Lancet Publishing Group
Collection year 2011
Language eng
Formatted abstract
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. © 2010 Elsevier Ltd.
Keyword Drug resistance
Microbial
Enterobacteriaceae
Enterobacteriaceae infections
Humans
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2011 Collection
 
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Created: Fri, 18 Feb 2011, 15:15:33 EST by Caroline Irle on behalf of UQ Centre for Clinical Research