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NDM-1 Alert! Multidrug resistent Klebsiella Pneumonia

Multidrug resistant Klebsiella pneumonia

New Delhi metallo-beta-lactamase-1 (NDM-1) is an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics. These include the antibiotics of the carbapenem family (Ertapenem, Imipenem, Doripenem and Meropenem), which are a mainstay for the treatment of antibiotic-resistant bacterial infections. The most common bacteria that make this enzyme are Gram-negative such as Escherichia coli and Klebsiella pneumoniae, but the gene for NDM-1 can spread from one strain of bacteria to any another by horizontal gene transfer.

The NDM-1 enzyme was named after New Delhi, the capital city of India, as it was first described by Yong et al. in December 2009. Infections has now been reported from all over the world including United Kingdom, USA, Pakistan, Canada, Australia and Japan. In South Africa we have now also seen recent reports of these "superbugs".

Allowing patterns of human travel and migration, and the many international residents who receive medical treatment in India, we believe that our healthcare will be repeatedly challenged by imported producers.

All isolates were resistant to multiple different classes of antibiotics, including beta-lactam antibiotics, fluoroquinolones, and aminoglycosides, but most were still susceptible to the polymyxin antibiotic colistin.

The only way to currently combat the spread of NDM-1 is through surveillance,(rectal swab or stool sample) prompt identification and isolation of infected patients, disinfecting hospital equipment, and thorough hand-hygiene procedures in hospitals. This is going to be a challenge and will require international cooperation.

Actions advised

  • Be alert to the increase in carbapenemase-producing Enterobacteriaceae, and the growing importance of NDM -1 enzyme.
  • Recognise exposure to healthcare systems in India and Pakistan (and travel in general) as additional major risk factors for infection or colonization with multiresistant, carbapenemaseproducing Enterobacteriaceae
  • Recognise exposure to other hospitals as a risk factor for infection or colonisation.
  • Patients infected with producers should be isolated to prevent onward transmission in hospitals; carriage in the patient's faecal flora should be examined for producers of the same or different species; similar screening of close unit contacts should be strongly considered.

Please submit a rectal swab or stool sample. We will screen with a culture method and confirm the presence of NDM-1 or KPC genes with PCR.
(Logged as PCR klebsiella pneumonia).

Download this article in PDF format - NDM-1 alert Newsletter Oct 2011