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  Table of Contents  
CORRESPONDENCE
Year : 2015  |  Volume : 33  |  Issue : 4  |  Page : 609-610
 

Rapid emergence of New Delhi Metallobetalactamase-1 among clinical isolates from blood - a comparative study over two periods, 12 months apart


Department of Microbiology, Maulana Azad Medical College, New Delhi, India

Date of Submission11-Jan-2014
Date of Acceptance02-Feb-2015
Date of Web Publication16-Oct-2015

Correspondence Address:
V Jain
Department of Microbiology, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.167317

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How to cite this article:
Jain V, Prakash S K, Kumar S, Jha H. Rapid emergence of New Delhi Metallobetalactamase-1 among clinical isolates from blood - a comparative study over two periods, 12 months apart. Indian J Med Microbiol 2015;33:609-10

How to cite this URL:
Jain V, Prakash S K, Kumar S, Jha H. Rapid emergence of New Delhi Metallobetalactamase-1 among clinical isolates from blood - a comparative study over two periods, 12 months apart. Indian J Med Microbiol [serial online] 2015 [cited 2019 Dec 15];33:609-10. Available from: http://www.ijmm.org/text.asp?2015/33/4/609/167317


Dear Editor,

Carbapenem resistance due to New Delhi Metallobetalactamase-1 (NDM-1) is becoming a global menace. Even though it has been claimed that this gene originated in New Delhi,[1] there is a paucity of literature on NDM-1 from healthcare centres in New Delhi tself. The need of the hour is to [1] quantify the burden of carbapenem resistance caused by NDM-1,[2] to review its change over time and [3] to evaluate new therapeutic options.

We undertook a study with an interest in local epidemiology, in a 2000-bedded tertiary care referral hospital in New Delhi that caters to an annual inpatient load of more than 58,000. Consecutive clinical specimens of blood from inpatients suffering from septicaemia caused by enterobacteriaceae during 2 months, January 2012 and January 2013, were the specimens under study.

The method of detection of the blaNDM-1 gene was conventional polymerase chain reaction (PCR), followed by sequencing of the 475bp amplicon. A known blaNDM-1-positive Klebsiella pneumoniae strain was used as the positive control, while deoxyribonucleic acid (DNA) extracted from  Escherichia More Details coli 25922 was used as the negative control for this study.

Nine consecutive enterobacteriaceae isolates were cultured from septicaemic patients in January 2012. None was carbapenemase-, MBL (Metallo-beta-lactamase)- or NDM-1-positive. Three (33%) were ESBL (Extended spectrum beta lactamase) producers.

Fifteen consecutive isolates were obtained in January 2013. Nine (60%) were ESBL and six (40%) were carbapenemase producers. While no resistance against meropenem was detected in January 2012, the figure rose to 40% in January 2013. Three Klebsiella pneumoniae were NDM-1-positive [Figure 1] and susceptible to colistin by E-test. One hundred percent colistin susceptibility has been previously reported from Haryana.[2]
Figure 1: Lane A = Positive control Lane B = Negative control Lane C = DNA marker with a prominent band corresponding to 500bp Lanes D, E and F = 475bp amplicons of blaNDM-1 gene found in the three Klebsiella pneumoniae Scientific Name Search  isolates in this study

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Tigecycline resistance seen in a single strain in our study Minimal inhibitory concentration (MIC = 2 µg/ml) is an alarming indication of the shrinking therapeutic options for the management of such blaNDM-1-positive strains. Tigecycline resistance of 06.81% has been previously reported from Chennai [2] and 27.27% from the SENTRY study.[3]

Thus, a sharp rise in carbapenem resistance and NDM-1 production was noticed in the 1-year interval. Two of the three NDM-1-positive isolates had been obtained from infants. Tigecycline resistance was also documented. Antimicrobial stewardship backed by good clinician–laboratory communication is the only way forward.

Acknowledgement

The authors would like to acknowledge Dr. Rafael Canton and Dr. Maria Isabel Morosini, Ramon Y Cajal Hospital, Madrid, Spain, for providing control strains required for modified Hodge test. We are extremely grateful to Dr. Vikas Manchanda, Head of department of Microbiology, CNBC, New Delhi for providing the blaNDM-1-positive control strain of Klebsiella pneumonia.[4]

Financial support and sponsorship

Nil.

Conflicts of interest.

There are no conflicts of interest.

 
 ~ References Top

1.
Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, et al. Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046-54.  Back to cited text no. 1
    
2.
Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: A molecular, biological, and epidemiological study. Lancet Infect Dis 2010;10:597-602.  Back to cited text no. 2
    
3.
Castanheira M, Deshpande LM, Mathai D, Bell JM, Jones RN, Mendes RE. Early dissemination of NDM-1- and OXA-181-producing Enterobacteriaceae in Indian hospitals: Report from the SENTRY Antimicrobial Surveillance Program, 2006-2007. Antimicrob Agents Chemother 2011;55:1274-8.  Back to cited text no. 3
    
4.
Manchanda V, Rai S, Gupta S, Rautela RS, Chopra R, Rawat DS, et al. Development of TaqMan real-time polymerase chain reaction for the detection of the newly emerging form of carbapenem resistance gene in clinical isolates of Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii. Indian J Med Microbiol 2011;29:249-53.  Back to cited text no. 4
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