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

  • Medical Author:

    Sandra Gonzalez Gompf, MD, FACP is a U.S. board-certified Infectious Disease subspecialist. Dr. Gompf received a Bachelor of Science from the University of Miami, and a Medical Degree from the University of South Florida. Dr. Gompf completed residency training in Internal Medicine at the University of South Florida followed by subspecialty fellowship training there in Infectious Diseases under the directorship of Dr. John T. Sinnott, IV.

  • 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.

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

Many NDM-1 infections will respond to treatment. Colistin is an older antibiotic that has not been used much in recent decades due to toxicity. A few NDM-1 strains have been sensitive to tigecycline (Tygacil), but this agent is not the first choice in serious infections, because it does not achieve high levels in the blood. Further, it only stops bacteria from multiplying, rather than destroying them. A few NDM-1s have been susceptible to aztreonam, although most U.S. strains have not. Research for new treatments is ongoing.

What is the prognosis for a person infected with NDM-1 producing bacteria?

NDM-1 infections can be successfully treated if they are recognized early and if colistin or other appropriate agents are used promptly. If a CRE infection is severe or the bacteria is aggressive, death is very possible. Death rate from KPC infections, for example, may be as high as 40%.

Is it possible to prevent infections with bacteria containing NDM-1?

Several major guidelines have been published about preventing resistant bacteria, and hospital accrediting organizations cannot accredit facilities that do not adhere to them. Hospital Infection Control programs monitor for resistant bacteria and use methods of blocking the spread of disease. Barriers between contaminated surfaces and health-care workers prevent transfer of bacteria from an infected patient to another patient or worker. Barriers for NDM-1 must be extremely strict to contain it. Patients with NDM-1 strains are placed in private rooms. Health-care workers must put on a gown and gloves when entering the room and carefully dispose of them in the room before leaving. The number of people caring for the patient, entering and leaving the room, and the patient's movements out of the room are minimized.

Antimicrobial Stewardship Programs are also critical to controlling resistant bacteria. Such programs help to ensure that antibiotics are used for the right reason, at the right dose, and for the minimum time necessary to treat bacterial infections. This may involve an infectious-disease doctor and pharmacist reviewing antibiotic use and providing personalized feedback to patients' doctors. Carbapenem antibiotics are only given intravenously and should only be used when bacteria are resistant to other drugs.

In the community, it is important that primary-care doctors and other health professionals prescribe antibiotics just as carefully. People should become informed about the pros and cons of antibiotics. Antibiotics do not kill viruses that cause most colds, ear and sinus infections, and bronchitis. They do kill friendly flora though, which can result in worse infections and antibiotic resistance. In addition, antibiotic allergies can be life-threatening; if you develop allergies to antibiotics because of overuse, it can reduce your options for treating serious infections even more than having an antibiotic-resistant bacterial infection.

Medically Reviewed by a Doctor on 9/23/2016

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