New Dehli metallo-beta-lactamase (NDM-1) Enterobacteriaceae
New Delhi strain hits U.S.: Contact precautions, assess travel history on all CRE isolates. Antimicrobial resistance in Gram-negative bacteria is a well-recognized problem; and, a new resistance mechanism found in three U.S. Enterobacteriaceae could compound this challenge.
While, the most common mechanism of carbapenem resistance among Enterobacteriaceae in the United States remains the production of the Klebsiella pneumoniae carbapenemase (KPC), a highly drug-resistant gram negative bacterial strain that is emerging rapidly in hospitals in India has been detected in patients in three U.S. states. The New Delhi metallo-beta-lactamase (NDM-1) carries not only the threat of virtually untreatable infections, but contains a transferable plasmid that can impart drug resistance to other pathogens.
Clinicians should be aware of the possibility of NDM-1–producing Enterobacteriaceae in patients who have received medical care in India and Pakistan, and should specifically inquire about this risk fac¬tor when carbapenem-resistant Enterobacteriaceae are identified. The CDC is asking that carbapenem-resistant isolates from patients who have received medical care within 6 months in India or Pakistan be forwarded through state public health laboratories to CDC for further characterization.
1. Centers for Disease Control and Prevention. Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta -Lactamase -- United States, 2010. MMWR 2010;59:750.