Emergence of New Delhi Metallo-Beta-Lactamase (NDM-1) and Klebsiella pneumoniae Carbapenemase (KPC-2) in South Africa

Abstract

This report documents emergence of New Delhi metallo-beta-lactamase (NDM-1) and Klebsiella pneumoniae carbapenemase (KPC-2) in K. pneumoniae and Enterobacter cloacae in South Africa. NDM-1 producers have not been described in South Africa, and this is the first instance that KPC producers have been identified in Africa. The two patients infected with these carbapenemase-producing bacteria demised. CASE REPORTS

The spread of carbapenem-resistant Enterobacteriaceae in South Africa: Risk factors for acquisition and prevention

“…Since 1 March 2010 the Molecular Biology Laboratory at the Ampath National Reference Laboratory has been screening Enterobacteriaceae for the presence of these novel genes, and recently the emergence of NDM-1 for the first time in South Africa, and KPC-2 for the first time in Africa, was documented among clinical isolates of K. pneumoniae and Enterobacter cloacae in hospitalised patients in Johannesburg and Pretoria, respectively. 4 As depicted in Fig. 1, the emergence of the broad-spectrum antibiotic-inactivating enzyme, OXA-48, and its derivatives among Enterobacteriaceae from hospitalised patients in Johannesburg, Cape Town and Port Elizabeth has been confirmed (unpublished, J Coetzee, February 2012).…”

“…Numerous outbreaks and epidemics with these organisms have been reported, they have become endemic in several institutions, and increased mortality has been ascribed to them. [2][3][4] The imminent threat of untreatable infections is highlighted by the recent emergence, and inter-hospital spread in Greece, of CRE resistant even to colistin.…”

“…[2][3][4] These GNB are resistant to all standard antimicrobial agents and salvage therapy with tigecycline, colistin and/or fosfomycin has become the last resort in life-threatening infections. Numerous outbreaks and epidemics with these organisms have been reported, they have become endemic in several institutions, and increased mortality has been ascribed to them.…”

Emerging Carbapenem-Resistant <i>Enterobacter cloacae</i> Producing OXA-48-, VIM- and IMP-Type-<i>β</i>-Lactamases in Eastern Cape Hospitals in South Africa

“…The production of IMP and VIM β-lactamases in the hospital environment has become a serious concern [19] [20]. In South Africa, the emergence of bla NDM , bla KPC , bla VIM and bla OXA-48 and its variants produced by enterobacteriaceae have been reported [21]- [23]. However, to our knowledge there are no studies that document bla IMP genes in E. cloacae in South Africa.…”

A Region-specific Treatment Strategy To Address The Problem Of Drug Resistance By NDM-1-producing Pathogens

“…Several variants of NDM-1 have been reported, NDM-6 (GenBank: JN967644.1) being the latest addition to the list. Reports about NDM-1 producing pathogens continue to arrive as we are writing this article in 2012 [22,23].…”