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LETTER TO EDITOR  
Year : 2011  |  Volume : 3  |  Issue : 3  |  Page : 309
The New Delhi Metallo-Beta-Lactamases: Their origins and implication for the intensivist


1 Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, India
2 Department of Microbiology, Christian Medical College and Hospital, Vellore, India

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Date of Web Publication6-Aug-2011
 

How to cite this article:
Chacko B, Peter JV, Balaji V. The New Delhi Metallo-Beta-Lactamases: Their origins and implication for the intensivist. J Global Infect Dis 2011;3:309

How to cite this URL:
Chacko B, Peter JV, Balaji V. The New Delhi Metallo-Beta-Lactamases: Their origins and implication for the intensivist. J Global Infect Dis [serial online] 2011 [cited 2019 Aug 18];3:309. Available from: http://www.jgid.org/text.asp?2011/3/3/309/83540


Sir,

In the context of increased isolation globally of carbapenem-resistant Enterobacteriaceae (KPC-1 to KPC-10), the emergence of the New-Delhi metallo-beta-lactamase-1 (NDM-1) strain is not surprising. We however question its proposed Asian origin in the recent "Lancet Infectious Diseases" publication. [1] In the Lancet study, [1] the fact that there were only 59% of patients with history of travel from, or surgery in, Asia; and their observation "we could not prove statistically significant strain relatedness between the Indian and UK isolates" suggest that acquisition of infection and resistance could have occurred within the UK. More rigid methods - akin to eBURST analysis, which predicted the ancestral clonal complex for Methicillin-resistant Staphylococcus aureus (MRSA) [2] - need to be used to attribute causality.

In India, NDM-1 isolates are increasing. [3] In our 2,300-bed hospital, 45 carbapenem-resistant Klebsiella pneumoniae strains (blood=36, endotracheal aspirate=9), sensitive only to colistin and tigecycline, were characterized by PCR. [3] Thirty-six (80%) strains expressed the bla NDM-1 gene. Three randomly chosen NDM-1 isolates were sequenced and BLAST-matched, with 100% concurrence (Gene-bank no. HQ171206). Given this scenario, in nosocomial sepsis with shock /organ dysfunction, empiric antibiotic therapy may need to be colistin or tigecycline. With few drugs in the horizon to combat multidrug-resistant organisms, global focus should include tackling irrational antibiotic use, ensuring antibiotic stewardship [4] and strict infection control policies. This task is likely to be more arduous in developing than in developed countries, where measures have been in place for some time.

 
   References Top

1.Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, 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;10:597-602.  Back to cited text no. 1
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2.Enright MC, Robinson DA, Randle G, Feil EJ, Grundmann H, Spratt BG. The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proc Natl Acad Sci USA 2002;28:7687-92.  Back to cited text no. 2
    
3.Deshpande P, Rodrigues C, Shetty A, Kapadia F, Hedge A, Soman R. New Delhi Metallo-beta lactamase (NDM-1) in Enterobacteriaceae: Treatment options with carbapenems compromised. J Assoc Physicians India 2010;58:147-9.  Back to cited text no. 3
[PUBMED]    
4.Bruce J, Mackenzie FM, Cookson B, Mollison J, van der Meer JW, Krcmery V, et al. Antibiotic stewardship and consumption: Findings from a pan-European hospital study. J Antimicrob Chemother 2009;64:853-60.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
John Victor Peter
Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.83540

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This article has been cited by
1 Detection of NDM-1 in clinical isolates of Klebsiella pneumoniae from northeast India
Bora, A. and Ahmed, G.
Journal of Clinical and Diagnostic Research. 2012; 6(5): 794-800
[Pubmed]



 

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