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

Abstract

SummaryBackgroundGram-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.MethodsEnterobacteriaceae 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.FindingsWe 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.InterpretationThe potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.FundingEuropean Union, Wellcome Trust, and Wyeth.

Characterization and sensitivity to antibiotics of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units

“…to CS, which is one of the last resort antibiotics for multidrug resistant A. baumannii and P. aeruginosa. 20,21 Analogously, a previous study performed at the Hermanos Ameijeiras Hospital (2002)(2003)(2004)(2005)(2006) by other group of researchers, also demonstrated the existence of Acinetobacter spp. in the ICUs.…”

Exploring the evidence base for national and regional policy interventions to combat resistance

“…[82][83][84][85] Responsible use in the animal sector AMR in animals represents a significant problem for human health [86][87][88] and the emergence of multidrug resistant bacterial strains and strains resistant to antimicrobials considered critically important in human medicine is of concern. [89][90][91] Bacteria hosted by animals can reach humans through direct contact, food and/or the environment. 92 Non-therapeutic use of antimicrobials in animals for growth promotion has been associated with high levels of AMR in the animal reservoir.…”

Synthesis and antibacterial activity of novel 2-(arylimino)thiazolidin-4-one and 2-(benzylidenehydrazono)-3-arylthiazolidin-4-one derivatives

“…It has a note worthy impact on the mortality rates, morbidity rates and the financial burden associated. Although various novel antibacterial drugs had been introduced into the market in the past decades, the prevalence of multidrug-resistant pathogens remains among the major health problems which raises severe concern around the globe (Bassetti et al, 2013;Butler et al, 2013;Kumarasamy et al, 2010;Lewis, 2013;Pendleton et al, 2013). Staphylococci and Enterococci are Gram-positive bacteria that are responsible for several community and hospital acquired infections.…”