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Extensively Drug-Resistant New Delhi Metallo-β-Lactamase–Encoding Bacteria in the Environment, Dhaka, Bangladesh, 2012 - Volume 21, Number 6—June 2015 - Emerging Infectious Disease journal - CDC

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Extensively Drug-Resistant New Delhi Metallo-β-Lactamase–Encoding Bacteria in the Environment, Dhaka, Bangladesh, 2012 - Volume 21, Number 6—June 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 6—June 2015


Extensively Drug-Resistant New Delhi Metallo-β-Lactamase–Encoding Bacteria in the Environment, Dhaka, Bangladesh, 2012



Technical Appendicies

Mark A. TolemanComments to Author , Joachim J. Bugert, and Syed A. Nizam
Author affiliations: Cardiff University, Heath Park Campus, Cardiff, Wales, UK


Carriage of the New Delhi metallo-β-lactamase variant 1 (NDM-1) enables drug resistance to move between communities and hospitals. In Bangladesh, we found the blaNDM-1 gene in 62% of environmental waters and in fermentative and nonfermentative gram-negative bacteria. Escherichia coli sequence type (ST) 101 was most commonly found, reflecting a common global relationship between ST101 and NDM-1.
Carbapenemases, bacterial enzymes that typically inactivate most of the β-lactam class of antimicrobial drugs, have emerged rapidly over the past decade (1). These resistance mechanisms are often accompanied by other resistance alleles, and together they can confer extensive drug resistance, leaving minimal treatment options (2). The New Delhi metallo-β-lactamase variant 1 (NDM-1), a chimera formed by the fusion of 2 resistance genes, is unique among the carbapenemases (3). Since its description in 2009, NDM-1 has spread rapidly to many countries worldwide and appears to be endemic in South Asia (1,4,5). A study of the environment in New Delhi, India, showed that ≈30% of surface waters and sewage was contaminated with NDM-1; the enzyme was also detected in drinking water (6). In addition, high rates of NDM-1 gut carriage have been found in the community and in hospitals in Pakistan (7). High rates of gut carriage can lead to contamination of drinking water and food through inadequate sewage treatment. Furthermore, gut carriage of NDM-1–encoding Escherichia coli can lead to common community-acquired infections (e.g., urinary tract infections), which often require hospitalization (8) and enable resistance mechanisms to move between community and hospital sectors. Indirect studies in 2009 and 2010 showed that NDM-1 was not present in the Bangladesh environment (9,10). To determine whether NDM-1 is now present in Bangladesh, we surveyed the environmental waters of Dhaka.
Dr. Toleman is a senior lecturer at Cardiff University. His recent work includes the discovery of the ISCR(insertion sequence common region) elements, NDM-1, and the formation of NDM-1 by an unusual genetic fusion event.


This work was funded by grants from the National Institute for Social Care and Health Research (grant no. HF-11-24) and from the Medical Research Council (grant no. G1100135).


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Technical Appendix

Suggested citation for this article: Toleman MA, Bugert JJ, Nizam SA. Extensively drug-resistant New Delhi metallo-β-lactamase–encoding bacteria in the environment, Dhaka, Bangladesh, 2012. Emerg Infect Dis. 2015 Jun [date cited]. http://dx.doi.org/10.3201/eid2106.141578
DOI: 10.3201/eid2106.141578

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