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Medical Author:

Mary D. Nettleman, MD, MS, MACP

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.

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Medical Editor:

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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In this Article

• What is NDM-1?
• What causes NDM-1 to be produced in bacteria?
• What are symptoms and signs of a person infected with bacteria carrying NDM-1?
• How are bacteria that produce NDM-1 identified?
• What is the treatment for an infection caused by bacteria that make NDM-1?
• What is the prognosis for a person infected with NDM-1producing bacteria?
• Can infections with bacteria containing NDM-1 be prevented?
• Where can people find more information about NDM-1 producing bacteria?
• NDM-1 At A Glance
• Find a local Doctor in your town
• NDM-1 Index

NDM-1 infections can be successfully treated if they are identified early and if colistin or other appropriate agents are used promptly. As stated above, antibiotic sensitivity testing is standard in clinical laboratories and can be used to identify carbapenem-resistant strains and to guide antibiotic therapy. However, antibiotic sensitivity testing usually takes two days because the bacteria must be cultured in the laboratory.

The risk of person-to-person spread of NDM-1 infection can be reduced by practicing good hand hygiene. This includes washing or disinfecting hands after using the bathroom and before preparing food. In hospitals, patients with suspected NDM-1 infections should be placed in a private room and cover gowns and gloves should be used by health-care personnel. Other barrier methods should be used if contamination is likely (for example, eye protection if splashing is possible). Strict hand hygiene should be observed. Hospitals should ensure that their laboratories are equipped to test for carbapenem resistance and hospital infection-control programs should review resistance patterns regularly.

To reduce the risk that NDM-1 will develop in bacteria, it is important to use existing antibiotics wisely. Carbapenem antibiotics should only be used when bacteria are resistant to older agents. Antibiotics should always be dosed appropriately.

More information about NDM-1 is available from the following sites:

Centers for Disease Control and Prevention
"Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase --- United States, 2010." http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm5924a5.htm

Centers for Disease Control and Prevention
"Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities." <http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm5810a4.htm>.

• NDM-1 stands for New Delhi metallo-beta-lactamase, which is an enzyme that destroys beta-lactam antibiotics including the penicillins, cephalosporins, and carbapenems.
• NDM-1 has been reported most commonly from India and Pakistan but is spreading throughout the world as people travel from country to country.
• The first three cases of NDM-1 in the United States were reported in June 2010.
• Bacteria that express NDM-1 usually have other resistance factors. Most strains are resistant to all commonly used antibiotics.
• Routine antibiotic-sensitivity testing can detect resistance to beta-lactam antibiotics. Specific testing for NDM-1 is not routinely available. 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.
• Most NDM-1 strains remain sensitive to an older, little-used antibiotic called colistin. Some strains have also been sensitive to tigecycline or aztreonam.
• NDM-1 is carried by bacteria that commonly inhabit the bowel. Strains spread from person to person through contact with contaminated hands or items.
• Good hand hygiene practices will reduce the risk of spreading or acquiring NDM-1. In hospitals, hand hygiene is critical and patients with NDM-1 should be placed in private rooms and health-care workers should used gowns and gloves when entering the room.
• To reduce the risk that NDM-1 will arise, physicians and hospitals should ensure that antibiotics are used judiciously and appropriately.

REFERENCES:

Kumarasamy, K.K., M.A. Toleman, T.R. Walsh, J. Bagaria, F. Butt, et al. "Emergence of a New Antibiotic Resistance Mechanism in India, Pakistan, and the UK: A Molecular, Biological, and Epidemiological Study." Lancet Infect Dis 10 (2010): 597-602.

United States. Centers for Disease Control and Prevention. "Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase --- United States, 2010." MMWR 59.24 (2010): 750. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5924a5.htm>.

United States. Centers for Disease Control and Prevention. "Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities." MMWR 58.10 Mar. 20, 2009: 256-260. <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a4.htm>.