Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study
Open accessAbstract
BACKGROUND: Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-beta-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. METHODS: Enterobacteriaceae isolates were studied from two major centres in India--Chennai (south India), Haryana (north India)--and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene bla(NDM-1) was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan. FINDINGS: We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries. INTERPRETATION: The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.
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NDM-1 was identified in 2008 in a K. pneumoniae isolate recovered from a Swedish patient who had been previously admitted to a hospital in New Delhi, India.
“More recently (2008), a new carbapenemase was identified in a K. pneumoniae isolate recovered from a Swedish patient who had been previously admitted to a hospital in New Delhi, India.”
From Mechanisms of Antibiotic Resistance (2016) · cites this paper as [29]
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- Authors
- Kumarasamy, K. K., Toleman, M. A., Walsh, T. R., Bagaria, J., Butt, F., Balakrishnan, R., Chaudhary, U., Doumith, M., Giske, C. G., Irfan, S., Krishnan, P., Kumar, A. V., Maharjan, S., Mushtaq, S., Noorie, T., Paterson, D. L., Pearson, A., Perry, C., Pike, R., Rao, B., Ray, U., Sarma, J. B., Sharma, M., Sheridan, E., Thirunarayan, M. A., Turton, J., Upadhyay, S., Warner, M., Welfare, W., Livermore, D. M., & Woodford, N.
- Affiliations
- Cardiff University (GB)
- Health Protection Agency (GB)
- Shaukat Khanum Memorial Cancer Hospital and Research Center (PK)
- Karolinska University Hospital (SE)
- Aga Khan University (PK)
- University of Madras (IN)
- Amrita Institute of Medical Sciences and Research Centre (IN)
- The University of Queensland (AU)
- Apollo Gleneagles Hospitals (IN)
- Northumbria Healthcare NHS Foundation Trust (GB)
- Apollo Hospitals (IN)
- Institute of Medical Sciences (IN)
- Corresponding author
- Walsh, Timothy R
- ORCID
- Toleman, Mark A
- Walsh, Timothy R
- Chaudhary, Uma
- Doumith, Michel
- Giske, Christian G
- Irfan, Seema
- Krishnan, Padma
- Kumar, Anil V
- Maharjan, Sunil
- Mushtaq, Shazad
- Paterson, David L
- Perry, Claire
- Pike, Rachel
- Rao, Bhargavi
- Ray, Ujjwayini
- Sarma, Jayanta B
- Sheridan, Elizabeth
- Turton, Jane
- Upadhyay, Supriya
- Welfare, William
- Livermore, David M
- Woodford, Neil
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 10
- Issue
- 9
- Pages
- 597-602
- ISSN
- 1473-3099 (ISSN-L)
- PMC
- PMC2933358
- OpenAlex
- W2154556219
- Cited by
- 2,922
- References
- 33
- Citations by year
- 2026: 63 · 2025: 91 · 2024: 86 · 2023: 139 · 2022: 161 · 2021: 161 · 2020: 176 · 2019: 174 · 2018: 179 · 2017: 170 · 2016: 184 · 2015: 191 · 2014: 229 · 2013: 252 · 2012: 288
- FWCI
- 136.50
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- EU (LSHM-CT-2005-018705)
- Wellcome Trust (084627/Z/08)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Infections and bacterial resistance
- Keywords
- New Delhi metallo-beta-lactamase-1, NDM-1, carbapenem resistance, multidrug-resistant Enterobacteriaceae, Klebsiella pneumoniae, Escherichia coli, plasmid-mediated gene transfer, molecular epidemiology, clonal diversity, antibiotic resistance surveillance, India, Pakistan, United Kingdom
- MeSH terms
- Drug Resistance, Microbial, Enterobacteriaceae, Enterobacteriaceae Infections, United Kingdom, Humans, India, Pakistan, Plasmids, Travel, Polymerase Chain Reaction
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