NDM-1 (New Delhi metallo-beta-lactamase)

  • Medical Author:
    Mary D. Nettleman, MD, MS, MACP

    Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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How are bacteria that produce NDM-1 identified?

It is standard practice to test bacteria for sensitivity to antibiotics. Strains that produce NDM-1 will show resistance to penicillins, cephalosporins, and carbapenems. Because carbapenem resistance is still relatively rare, resistance to these agents should raise suspicion of NDM-1, although not all of these resistant strains will be NDM-1 strains. If the patient has recently been to an area where NDM-1 is common, like India or Pakistan, this increases the probability that the strain is producing NDM-1.

Specific testing for NDM-1 is not routinely available in clinical laboratories. Fortunately, it is not necessary to determine if carbapenem resistance is specifically due to NDM-1 because treatment is guided by the antibiotic sensitivity testing. If a carbapenem-resistant isolate is recovered from a patient who has received medical care in India or Pakistan, it should be sent to a state public-health laboratory, which will forward it to the Centers for Disease Control and Prevention for specific testing for NDM-1. Patients who have bacteria isolated from an infected site that produce NDM-1 are then definitively diagnosed as having an infection caused by bacteria that produce NDM-1.

What is the treatment for an infection caused by bacteria that make NDM-1?

Treatment is guided by the antibiotic resistance pattern. Many NDM-1 strains are resistant to all antibiotics except for colistin and tigecycline. Colistin is an older antibiotic that has not been used much in recent decades, because it is somewhat more toxic than other antibiotics. A few NDM-1 strains have been sensitive to tigecycline (Tygacil), but this agent should be used cautiously in serious infections because it does not achieve high levels in the bloodstream. A few strains have also been sensitive to aztreonam, although the U.S. strains were not. Researchers have identified a new antibiotic compound that may inhibit NDM-1 containing bacterial topoisomerase function so the bacterial replication is inhibited or stopped. Unfortunately, the compound has not gone through any clinical trials and is not commercially available.

Medically Reviewed by a Doctor on 6/30/2015

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  • NDM-1 - Prevention

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