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). pp. 597-602. ISSN 1474-4457

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Abstract

Background Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-ß-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.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Rhiannon Harvey
Date Deposited: 05 Jul 2011 10:48
Last Modified: 07 May 2020 23:41
URI: https://ueaeprints.uea.ac.uk/id/eprint/33342
DOI: 10.1016/S1473-3099(10)70143-2

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