Emergence of multidrug-resistant NDM-1-producing Gram-negative bacteria in Bangladesh

Islam, Md. Rayhanul; Talukdar, Prabhat K.; Hoque, Ashfaqul; Huq, M. I.; Nabi, A.H.M. Nurun; Ahmed, Dilruba; Talukder, Kaisar A.; Pietroni, Mark; Hays, John P.; Cravioto, Alejandro; Endtz, Hubert P.

doi:10.1007/s10096-012-1601-2

Cited by 64 publications

(62 citation statements)

References 21 publications

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“…These three species are associated with a majority of clinical cases or incidents of carbapenem-resistant or NDM-1-producing bacteria worldwide, including in Bangladesh (1). In our previous studies, we found that Klebsiella pneumoniae and E. coli were the most common enteric Gram-negative organisms that possess the bla NDM-1 gene (2,15). In the present study, we identified a number of rarely reported species as NDM-1 producers.…”

Section: Discussionsupporting

confidence: 52%

“…New Delhi metallo-␤-lactamase (NDM) is the most recently described carbapenemase, and the rapid spread of NDM-1-producing bacteria constitutes a major global public health threat (1). The presence of NDM-1-producing organisms has been detected in clinical specimens (2)(3)(4), as well as in the aquatic environment of areas where bacterial infections are widespread. Contamination of surface water or drinking water with NDM-1-producing bacteria has been reported (5,6).…”

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confidence: 99%

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Environmental Spread of New Delhi Metallo-β-Lactamase-1-Producing Multidrug-Resistant Bacteria in Dhaka, Bangladesh

Islam

Hasan

et al. 2017

Appl Environ Microbiol

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Resistance to carbapenem antibiotics through the production of New Delhi metallo-␤-lactamase-1 (NDM-1) constitutes an emerging challenge in the treatment of bacterial infections. To monitor the possible source of the spread of these organisms in Dhaka, Bangladesh, we conducted a comparative analysis of wastewater samples from hospital-adjacent areas (HAR) and from community areas (COM), as well as public tap water samples, for the occurrence and characteristics of NDM-1-producing bacteria. Of 72 HAR samples tested, 51 (71%) samples were positive for NDM-1-producing bacteria, as evidenced by phenotypic tests and the presence of the bla NDM-1 gene, compared to 5 of 41 (12.1%) samples from COM samples (P Ͻ 0.001). All tap water samples were negative for NDM-1-producing bacteria. Klebsiella pneumoniae (44%) was the predominant bacterial species among bla NDM-1 -positive isolates, followed by Escherichia coli (29%), Acinetobacter spp. (15%), and Enterobacter spp. (9%). These bacteria were also positive for one or more other antibiotic resistance genes, including bla CTX-M-1 (80%), bla CTX-M-15 (63%), bla TEM (76%), bla SHV (33%), bla CMY-2 (16%), bla OXA-48-like (2%), bla OXA-1 (53%), and bla OXA-47-like (60%) genes. Around 40% of the isolates contained a qnr gene, while 50% had 16S rRNA methylase genes. The majority of isolates hosted multiple plasmids, and plasmids of 30 to 50 MDa carrying bla NDM-1 were self-transmissible. Our results highlight a number of issues related to the characteristics and source of spread of multidrug-resistant bacteria as a potential public health threat. In view of the existing practice of discharging untreated liquid waste into the environment, hospitals in Dhaka city contribute to the potential dissemination of NDM-1-producing bacteria into the community.IMPORTANCE Infections caused by carbapenemase-producing Enterobacteriaceae are extremely difficult to manage due to their marked resistance to a wide range of antibiotics. NDM-1 is the most recently described carbapenemase, and the bla NDM-1 gene, which encodes NDM-1, is located on self-transmissible plasmids that also carry a considerable number of other antibiotic resistance genes. The present study shows a high prevalence of NDM-1-producing organisms in the wastewater samples from hospitaladjacent areas as a potential source for the spread of these organisms to community areas in Dhaka, Bangladesh. The study also examines the characteristics of the isolates and their potential to horizontally transmit the resistance determinants. The significance of our research is in identifying the mode of spread of multiple-antibiotic-resistant organisms, which will allow the development of containment measures, leading to broader impacts in reducing their spread to the community.

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Section: Discussionsupporting

confidence: 52%

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confidence: 99%

Environmental Spread of New Delhi Metallo-β-Lactamase-1-Producing Multidrug-Resistant Bacteria in Dhaka, Bangladesh

Islam

Hasan

et al. 2017

Appl Environ Microbiol

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“…Several studies reported recognizing different health care facilities in Bangladesh as breeding grounds of pathogenic A. baumannii [21,22]. Several authors of Bangladesh cited about the recovery of MDRAB strains from clinical samples from Bangladesh [18][19][20][21][22].…”

Section: Resultsmentioning

confidence: 99%

“…Different researches have been conducted about A. baumannii infections and its resistance to different antimicrobials. Recovery of MDRAB isolates from different clinical samples has been reported in several reports in Bangladesh [18][19][20][21][22]. In a study conducted at the Dhaka Medical College Hospital (DMCH) reported by Khatun [21], 25 A. baumannii isolates were recovered from endotracheal aspirate samples of patients admitted to the ICU of DMCH.…”

Section: Introductionmentioning

confidence: 97%

Isolation and Identification of Multi-Drug Resistant Acinetobacter baumannii from a tertiary health care centre of Bangladesh

Dhar¹,

Mahmud²,

Chowdhury³

et al. 2017

IOSRJPBS

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“…In the following references, sequence type of NDM producing was not recorded (16,78,88,97,98,107,114,118,126,127,129,142,145,148,154) Chapter 1: A new paradigm presented by the blaNDM gene 37 …”

Section: Other Enterobacteriaceae Speciesmentioning

confidence: 99%

The genetic analysis of Enterobacteriaceae plasmids to provide insights into the acquisition and spread of the blaNDM gene

Wailan¹

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Treatment options for infections caused by pathogenic Gram-negative bacteria, especially those of the Enterobacteriaceae family, are becoming limited with the increase of antimicrobial resistance (AMR). β-lactamases are a major mechanism for AMR within the Enterobacteriaeae. The most problematic β-lactamases are carbapenemases, which confer resistance to carbapenems, the major last-line antimicrobial. A recently emerged carbapenemase that has globally disseminated is the NDM carbapenemase, provided by blaNDM genes. These blaNDM genes (and other AMR genes) are able to transmit between strains when inserted on extrachromosomal self-replicating DNA molecules known as 'plasmids'. AMR genes within Enterobacteriacae are frequently associated with specific bacterial species, clonal lineage, plasmid Incompatibility (Inc) types or transposable elements. The blaNDM genes however do not have this association when oberserved in the Enterobacteriaceae family. To address and characterise this new paradigm presented by blaNDM genes, this thesis presents the bioinformatic analysis of plasmids associated with the Enterobacteriaceae to provide insights into the acquisition and spread of the blaNDM gene and an epidemiological approach to assess its plasmid-mediated dissemination between genetically unrelated species.Specifically these aims were achieved by; firstly, the establishment of a recent account of the blaNDM gene from an epidemiological perspective using a novel genetic/molecular approach. This would identify the spread of individual plasmids carrying blaNDM across multiple species and patients, both within a single facility and across multiple national facilities. The approach combined in-depth bioinformatic analysis of blaNDM genetic contexts (NGCs) with common molecular epidemiology techniques. IncN2 (n=4) and IncA/C (n=3) were identified as the most common plasmids types carrying blaNDM across four patients within a Pakistani military hospital. These patients harboured between two and four NDM-1 producing Gram-negative bacilli of different ii species coresident in their stool samples. IncFII-types (n=7) and IncX3 (n=4) were the most common plasmid types carrying blaNDM amongst 12 Enterobacteriaceae isolates, each from different patients across multiple Australian healthcare facilities. These isolates each carried one plasmid harbouring blaNDM but only five different blaNDM genetic contexts were identified, indicating five particular plasmids with a specific NGC had disseminated amongst these 12 isolates.Secondly, to investigate transposable elements involved for insertion of the blaNDM gene into different plasmid types, the complete sequence of four plasmids carrying blaNDM (two IncA/C2 and two IncFIIY) was bioinformatically analysed. These plasmids were from four different clinical samples of four patients, comprised of Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli. Each plasmid was observed to acquire blaNDM by different mechanisms on very similar plasmid backbones. Transposable elements ...

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Emergence of multidrug-resistant NDM-1-producing Gram-negative bacteria in Bangladesh

Cited by 64 publications

References 21 publications

Environmental Spread of New Delhi Metallo-β-Lactamase-1-Producing Multidrug-Resistant Bacteria in Dhaka, Bangladesh

Environmental Spread of New Delhi Metallo-β-Lactamase-1-Producing Multidrug-Resistant Bacteria in Dhaka, Bangladesh

Isolation and Identification of Multi-Drug Resistant Acinetobacter baumannii from a tertiary health care centre of Bangladesh

The genetic analysis of Enterobacteriaceae plasmids to provide insights into the acquisition and spread of the blaNDM gene

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