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

Publication Type : Journal Article

Thematic Areas : Medical Sciences

Publisher : The Lancet Infectious Diseases

Source : Lancet Infect Disease, Volume 10, 2010

Url :

Keywords : adolescent, adult, aged, amikacin, antibiotic resistance, article, aztreonam, carbapenem, cefotaxime, cefpirome, ceftazidime, child, ciprofloxacin, Citrobacter freundii, colistin, digestion, Drug Resistance, Enterobacter cloacae, Enterobacteriaceae, Enterobacteriaceae Infections, Escherichia coli, female, gentamicin, Great Britain, hospital admission, human, Humans, imipenem, India, Klebsiella pneumoniae, major clinical study, male, meropenem, metallo beta lactamase, Microbial, minimum inhibitory concentration, minocycline, nonhuman, nuclease S1, Pakistan, piperacillin plus tazobactam, Plasmids, polymerase chain reaction, preschool child, priority journal, Proteus, pulsed field gel electrophoresis, school child, tigecycline, tobramycin, Travel, United Kingdom

Campus : Kochi

School : School of Medicine

Department : Microbiology

Year : 2010

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.

Cite this Research Publication : Karthikeyan K Kumarasamy, Mark A Toleman, Prof Timothy R Walsh, Jay Bagaria, Fafhana Butt, Ravikumar Balakrishnan, Uma Chaudhary, Michel Doumith, Christian G Giske, Seema Irfan, Padma Krishnan, Anil V Kumar, Sunil Maharjan, Shazad Mushtaq, Tabassum Noorie, David L Paterson, Andrew Pearson, Claire Perry, Rachel Pike, Bhargavi Rao, Ujjwayini Ray, Jayanta B Sarma, Madhu Sharma, Elizabeth Sheridan,
Mandayam A Thirunarayan, Jane Turton, Supriya Upadhyay, Marina Warner, William Welfare, David M Livermore, Neil Woodford"Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study", Lancet Infect Disease, Volume 10, 2010

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