NDM-1 (New Delhi metallo-beta-lattamasi-1) è un enzima in grado di rendere i batteri resistenti a un ampio spettro di antibiotici, including carbapenem, which is the last resort when other therapeutic drugs fail.
The gene coding for NDM-1, found in Enterobacteriaceae, it seems that it is spreading from the Indian subcontinent. It is a type of resistance plasmids, as such, can easily spread within bacterial populations. The international spread of plasmids in turn is facilitated by international travel.
The tank is located in India, Pakistan and Bangladesh and is due to factors that are not easily controlled: Excessive use of antibiotics, poor hygiene, overcrowding.
NDM-1 is now widespread throughout the Indian subcontinent in relation to water contamination and the presence of bacteria in the sludge producers NDM-1. As you know, there are many people in India who have not access to clean water and sanitation.
A study recently published in Lancet Infectious Diseases (1), identified in 2008-2009 numerous isolates of Escherichia coli and Klebsiella pneumoniae, with NDM-1:
44 to Chennai, 26 in Haryana (a state in northern India), 37 in Britain and 73 in various parts of India and Pakistan. The sites of isolation were made of urine, blood, wounds, sputum, and others. Diseases afflicting the patients were mainly represented by urinary tract infections, pneumonia and bacteremia / sepsis. Most of the isolates were sensitive only to colistin and tigecycline.
few blocks with the same mutation were identified in the United States (2) and Canada (3).
Two seem to be ways of disseminating this type of resistance outside the Indian subcontinent through travel international travel by members of the Indian diaspora who return regularly in the country of origin and travel the West who go to India or Pakistan and that for various reasons have a hospital stay in those nations. In several cases it was elective surgery, this area also included cosmetic surgery, which is much cheaper over there than in Europe or the United States (1).
Based the available data, it can be concluded that the resistance conferred by NDM-1 has the potential to become a major public health problem worldwide and requires international oversight (3). Unfortunately, there are few new antibiotics against Gram-negative bacteria present in development and none of them is active against bacteria producing NDM-1.
Bibliography
(1) KK Kumarasamy, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and Epidemiological Studies.
Lancet Infect Dis 2010, 10:597-602 doi: 10.1016/S1473-3099 (10) 70143-2
(2) Detection of Enterobacteriaceae isolates carrying metallo-beta -lactamase - United States, 2010. MMWR Morb Mortal Wkly Rep. 2010 Jun 25;59(24):750.
(3) Webster PC. Global action urged in response to new breed of drug-resistant bacteria. CMAJ October 19, 2010; 182 (15). First published September 20, 2010; doi:10.1503/cmaj.109-3675
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