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Year : 2012  |  Volume : 136  |  Issue : 6  |  Page : 1054-1059

Clinical correlates of New Delhi metallo-beta lactamase isolates - a survey of published literature

Department of Medicine, Sri Ramachandra Medical College & Research Institute, Chennai 600 116, India

Date of Web Publication4-Feb-2013

Correspondence Address:
Emmanuel Bhaskar
Department of Medicine, Sri Ramachandra Medical College & Research Institute, Chennai 600 116
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Source of Support: None, Conflict of Interest: None

PMID: 23391806

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How to cite this article:
Bhaskar E. Clinical correlates of New Delhi metallo-beta lactamase isolates - a survey of published literature. Indian J Med Res 2012;136:1054-9

How to cite this URL:
Bhaskar E. Clinical correlates of New Delhi metallo-beta lactamase isolates - a survey of published literature. Indian J Med Res [serial online] 2012 [cited 2021 Apr 19];136:1054-9. Available from:


Recent articles on New Delhi metallo-beta lactamase-1 (NDM-1) have raised alarm among clinicians worldwide on a potential pan-resistant pathogen which is said to be a global threat [1],[2] . However, a clinician will be interested to know the actual impact this pathogen has produced in terms of clinical illness, susceptible patients, treatment choice, community spread, hospital expenditure, morbidity and mortality.

The present attempt was made to analyse details of patient characteristics, foci of sepsis, culture specimen, drug used to treat the NDM-1 isolate and patients' outcome in published reports on NDM-1 isolates from January 2008 to October 20, 2011. A PubMed search with the keyword "New Delhi metallo-beta lactamase" was made from October 1 to October 20, 2011 to identify citations related to NDM-1 which yielded 106 reports; from which 33 reports which discussed at least one NDM-1 isolate, were selected for the review [1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33] . Six reports discussed five or more NDM-1 isolates and 27 reported less than 5 isolates (23 reported a single isolate). Commentaries on published clinical reports on NDM-1 and in vitro reports studying bacterial virulence, clonality and transmission of resistance were excluded. Full texts of all these articles were obtained.

A total of 327 NDM-1 isolates were reported from 22 countries (Sweden, India, United Kingdom, USA, Pakistan, Belgium, Germany, Netherlands, Denmark, Singapore, France, Oman, Taiwan, Australia, Austria, Kenya, Hong Kong, Italy, China, Serbia, Canada and Japan). Klebsiella pneumoniae (n=172) was the most frequent NDM-1 isolate followed by E. coli (n=91). [Table 1] shows the type of pathogen, country of origin and clinical details in studies reporting at least five isolates. In 10 reports it was mentioned that the NDM-1 isolate was a colonizer. Nineteen reports mentioned about the presence of foci of sepsis and 23 mentioned about culture specimen, though not for all samples. [Table 2] shows summary of seven reports which provided treatment details and patients' outcome. Of the 327 isolates, 219 (67%) were from patients admitted to hospitals in the Indian subcontinent largely due 180 isolates reported by Kumarasamy et al[2] which did have gross inadequacies as highlighted in a recent editorial [34] . Seven patients had no history of travel to the Indian subcontinent and details of travel were not mentioned in 53 cases.
Table 1. Summary of NDM-1 isolates, country where isolated, and the clinical correlates in studies reporting at least five isolates

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Table 2. Summary of 7 reports mentioning treatment details and patient outcome

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Given the fact that NDM-1 is a resistant pathogen, every attempt should have been made by the authors to document all relevant clinical details including treatment and patient outcome. The best description of patients' characteristics was observed in a report by Kus et al[23] which describes the patients' characteristics in detail including events on follow up. It may be interesting to note that this report highlights the fact that NDM-1 though a resistant pathogen can remain as a colonizer for 3 to 5 months without producing clinical infection despite presence of multiple co-morbidities in the patient [23] . It may be premature to think that NDM-1 is a resistant but a less virulent pathogen, although a few clinical facts point towards this possibility [21],[23] . The present attempt has made it obvious that most published data about NDM-1 are incomplete from a clinicians perspective.

A better understanding of the pathogen is possible only if epidemiological and clinical data are available about the isolates published so far. It will be a worthwhile effort if these details are collected in retrospect to the best extent possible since it may help us view a larger picture especially when it has been said that NDM-1 has a pandemic potential.

   References Top

1.Detection of Enterobacteriaceae isolates carrying metallo-beta-lactamase - United States, 2010. Centers for Diseases Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2010; 59 : 750.  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.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. 3
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8.0Poirel L, Lagrutta E, Taylor P, Pham J, Nordmann P. Emergence of metallo-â-lactamase NDM-1-producing multidrug-resistant Escherichia coli in Australia. Antimicrob Agents Chemother 2010; 54 : 4914-6.  Back to cited text no. 8
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10.Bogaerts P, Verroken A, Jans B, Denis O, Glupczynski Y. Global spread of New Delhi metallo-â-lactamase 1. Lancet Infect Dis 2010; 10 : 831-2.  Back to cited text no. 10
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12.Leverstein-Van Hall MA, Stuart JC, Voets GM, Versteeg D, Tersmette T, Fluit AC. Global spread of New Delhi metallo-â-lactamase 1. Lancet Infect Dis 2010; 10 : 830-1.  Back to cited text no. 12
13.Hammerum AM, Toleman MA, Hansen F, Kristensen B, Lester CH, Walsh TR, et al. Global spread of New Delhi metallo-â-lactamase 1. Lancet Infect Dis 2010; 10 : 829-30.  Back to cited text no. 13
14.Koh TH, Khoo CT, Wijaya L, Leong HN, Lo YL, Lim LC, et al. Global spread of New Delhi metallo-â-lactamase 1. Lancet Infect Dis 2010; 10 : 828.  Back to cited text no. 14
15.Poirel L, Hombrouck-Alet C, Freneaux C, Bernabeu S, Nordmann P. Global spread of New Delhi metallo-â-lactamase 1. Lancet Infect Dis 2010; 10 : 832.  Back to cited text no. 15
16.Chu Y-W, Tung VWN, Cheung TKM, Chu M-Y, Cheng N, Lai C, et al. Carbapenemases in enterobacteria, Hong Kong, China, 2009. Emerg Infect Dis 2011; 17 : 130-2.  Back to cited text no. 16
17.D'Andrea MM, Venturelli C, Giani T, Arena F, Conte V, Bresciani P, et al. Persistent carriage and infection by multidrug-resistant Escherichia coli ST405 producing NDM-1 carbapenemase: report on the first Italian cases. J Clin Microbiol 2011; 49 : 2755-8.  Back to cited text no. 17
18.Bogaerts P, Bouchahrouf W, de Castro RR, de Castro RR, Deplano A, Berhin C, et al. Emergence of NDM-1-producing Enterobacteriaceae in Belgium. Antimicrob Agents Chemother 2011; 55 : 3036-8.  Back to cited text no. 18
19.Chan HL, Poon LM, Chan SG, Teo JW. The perils of medical tourism: NDM-1-positive Escherichia coli causing febrile neutropenia in a medical tourist. Singapore Med J 2011; 52 : 299-302.  Back to cited text no. 19
20.Chen Y, Zhou Z, Jiang Y, Yu Y. Emergence of NDM-1-producing Acinetobacter baumannii in China. J Antimicrob Chemother 2011; 66 : 1255-9.  Back to cited text no. 20
21.Chen TL, Fung CP, Lee SD. Spontaneous eradication of a NDM-1 positive Klebsiella pneumoniae that colonized the intestine of an asymptomatic carrier. J Chin Med Assoc 2011; 74 : 104.  Back to cited text no. 21
22.Jovcic B, Lepsanovic Z, Suljagic V, Rackov G, Begovic J, Topisirovic L, et al. Emergence of NDM-1 metallo-â-lactamase in Pseudomonas aeruginosa clinical isolates from Serbia. Antimicrob Agents Chemother 2011; 55 : 3929-31.  Back to cited text no. 22
23.Kus JV, Tadros M, Simor A, Low DE, McGeer AJ, Willey BM, et al. New Delhi metallo-â-lactamase-1: local acquisition in Ontario, Canada, and challenges in detection. CMAJ 2011; 183 : 1257-61.  Back to cited text no. 23
24.Mochon AB, Garner OB, Hindler JA, Krogstad P, Ward KW, Lewinski MA, et al. New Delhi metallo-â-lactamase (NDM-1)-producing Klebsiella pneumoniae: case report and laboratory detection strategies. J Clin Microbiol 2011; 49 : 1667-70.  Back to cited text no. 24
25.Mulvey MR, Grant JM, Plewes K, Roscoe D, Boyd DA. New Delhi metallo-â-lactamase in Klebsiella pneumoniae and Escherichia coli, Canada. Emerg Infect Dis 2011; 17 : 103-6.  Back to cited text no. 25
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27.Peirano G, Ahmed-Bentley J, Woodford N, Pitout JD. New Delhi metallo-beta-lactamase from traveler returning to Canada. Emerg Infect Dis 2011; 17 : 242-4.  Back to cited text no. 27
28.Pfeifer Y, Witte W, Holfelder M, Busch J, Nordmann P, Poirel L. NDM-1-producing Escherichia coli in Germany. Antimicrob Agents Chemother 2011; 55 : 1318-9.  Back to cited text no. 28
29.Poirel L, Fortineau N, Nordmann P. International transfer of NDM-1-producing Klebsiella pneumoniae from Iraq to France. Antimicrob Agents Chemother 2011; 55 : 1821-2.  Back to cited text no. 29
30.Tijet N, Alexander DC, Richardson D, Lastovetska O, Low DE, Patel SN, et al. New Delhi metallo-beta-lactamase, Ontario, Canada. Emerg Infect Dis 2011; 17 : 306-7.  Back to cited text no. 30
31.Yamamoto T, Takano T, Iwao Y, Hishinuma A. Emergence of NDM-1-positive capsulated Escherichia coli with high resistance to serum killing in Japan. J Infect Chemother 2011; 17 : 435-9.  Back to cited text no. 31
32.Zarfel G, Hoenigl M, Leitner E, Salzer HJ, Feierl G, Masoud L, et al. Emergence of New Delhi metallo-â-lactamase, Austria. Emerg Infect Dis 2011; 17 : 129-30.  Back to cited text no. 32
33.Seema K, Ranjan Sen M, Upadhyay S, Bhattacharjee A. Dissemination of the New Delhi metallo-â-lactamase-1 (NDM-1) among Enterobacteriaceae in a tertiary referral hospital in north India. J Antimicrob Chemother 2011; 66 : 1646-7.  Back to cited text no. 33
34.Srivastava RK, Ichhpujani RI, Khare S, Rai A, Chauhan LS. Superbug - the so-called NDM-1. Indian J Med Res 2011; 133 : 458-60.  Back to cited text no. 34


  [Table 1], [Table 2]


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