New Delhi metallo-beta-lactamase-1
New Delhi metallo-beta-lactamase-1 enzyme confers bacterial resistance to antibiotics of the carbepenem class, often considered "last resort" drugs for multidrug resistant bacteria.[1] The gene to manufacture it can be horizontally transferred among different species of pathogenic bacteria. In September 2010, news media have been reporting bacteria with this resistance as a new "superbug".
Organisms that produce the enzyme are resistant to virtually all beta-lactam antibiotics except azneotram. [2] These organisms often are also resistant to fluoroquinolones and aminoglycosides.
First reported in Klebsiella pneumoniae, it has been reported in Acinetobacter, Escherichia coli, Citrobacter freundii, Enterobacter cloacae, and Morganella morganii. A number of cases have been found in Britain, Canada and the US in patients that went to India for medical procedures or were treated for emergencies while in India.[3]
Clinical management
"For all acute care facilities, the Centers for Disease Control and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend an aggressive infection control strategy, including managing all patients with carbepenem-resistant enterobacteriacease (CRE) using contact precautions and implementing Clinical and Laboratory Standards Institute (CLSI) guidelines for detection of carbapenemase production. In areas where CRE are not endemic, acute care facilities should
- review microbiology records for the preceding 6--12 months to determine whether CRE have been recovered at the facility,
- if the review finds previously unrecognized CRE, perform a point prevalence culture survey in high-risk units to look for other cases of CRE, and
- perform active surveillance cultures of patients with epidemiologic links to persons from whom CRE have been recovered.
In areas where CRE are endemic, an increased likelihood exists for importation of CRE, and facilities should consider additional strategies to reduce rates of CRE. Acute care facilities should review these recommendations and implement appropriate strategies to limit the spread of these pathogens. " [4]
Antibiotics to be considered in treatment include tigecycline, colistin, polymyxin B, and aztreonam, as well as combination therapy.[1]
References
- ↑ 1.0 1.1 Krishna B (2010 [cited 2010 Sep 14]), "New Delhi metallo-beta-lactamases: A wake-up call for microbiologists", Indian J Med Microbiol [serial online] 28: 265-6.
- ↑ >Nordmann P, Poirel L. (2002), "Emerging carbapenemases in Gram-negative aerobes", Clin Microbiol Infect 8: 321-31
- ↑ "NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan (02)", ProMED Emerging Disease Report, International Society for Infectious Diseases, 14 September 2010
- ↑ Centers for Disease Control and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (20 March 2009), "Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities", Morbidity and Mortality Weekly Report 58 (10): 256-260