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

full-text ►

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

Dispatch

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

On This Page

• The Study
• Conclusions
• Suggested Citation

Figures

• Figure 1
• Figure 2

Tables

• Table

Technical Appendicies

Downloads

• PDF[1.53 MB - 4 pgs]
• RIS[TXT - 2 KB]

Mark A. Toleman , Joachim J. Bugert, and Syed A. Nizam

Author affiliations: Cardiff University, Heath Park Campus, Cardiff, Wales, UK

Suggested citation for this article

Abstract

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.

Acknowledgment

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).

References

1. Patel G, Bonomo RA. “Stormy waters ahead”: global emergence of carbapenemases. Front Microbiol. 2013;4:48. PubMed
2. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.DOIPubMed
3. Toleman MA, Spencer J, Jones L, Walsh TR. blaNDM-1 is a chimera likely constructed in Acinetobacter baumannii. Antimicrob Agents Chemother.2012;56:2773–6. DOIPubMed
4. Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, Characterization of a new metallo-β-lactamase gene, blaNDM-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. DOIPubMed
5. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, 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.PubMed
6. Walsh TR, Weeks J, Livermore DM, Toleman MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis. 2011;11:355–62. DOIPubMed
7. Perry JD, Naqvi SH, Mirza IA, Alizai SA, Hussain A, Ghirardi S, Prevalence of faecal carriage of Enterobacteriaceae with NDM-1 carbapenemase at military hospitals in Pakistan, and evaluation of two chromogenic media. J Antimicrob Chemother. 2011;66:2288–94. DOIPubMed
8. Livermore DM. Has the era of untreatable infections arrived? J Antimicrob Chemother. 2009;64(Suppl 1):i29–36. DOIPubMed
9. Hasan B, Sandegren L, Melhus A, Drobni M, Hernandez J, Antimicrobial drug-resistant Escherichia coli in wild birds and free-range poultry, Bangladesh. Emerg Infect Dis. 2012;18:2055–8.PubMed
10. Hasan B, Drobni P, Drobni M, Alam M, Olsen B. Dissemination of NDM-1. Lancet Infect Dis. 2012;12:99–100, author reply 101–2. DOIPubMed
11. Talukdar PK, Rahman M, Nabi A, Islam Z, Hoque MM, Antimicrobial resistance, virulence factors and genetic diversity of Escherichia coli isolates from household water supply in Dhaka, Bangladesh. PLoS ONE. 2013;8:e61090. DOIPubMed
12. Islam MA, Huq M, Nabi A, Talukdar PK, Ahmed D, Occurrence and characterization of multidrug-resistant New Delhi metallo-β-lactamase-1–producing bacteria isolated between 2003 and 2010 in Bangladesh. J Med Microbiol. 2013;62:62–8. DOIPubMed
13. Islam MA, Nabi A, Rahman M, Islam M, Ahmed D, Prevalence of faecal carriage of NDM-1–producing bacteria among patients with diarrhoea in Bangladesh. J Med Microbiol. 2014;63:620–2. DOIPubMed
14. Pitout JD. Extraintestinal pathogenic Escherichia coli: a combination of virulence with antibiotic resistance. Front Microbiol. 2012;3:9.
15. Mushtaq S, Irfan S, Sarma JB, Doumith M, Pike R, Phylogenetic diversity of Escherichia coli strains producing NDM-type carbapenemases. J Antimicrob Chemother. 2011;66:2002–5. DOIPubMed

Figures

• Figure 1. Diversity of New-Delhi metallo-β-lactamase variant 1–encoding species and the number found in 58 locations in 7 regions (red circles on map) of Dhaka, Bangladesh, October 2012. Individual sampling sites...
• Figure 2. Sites where New-Delhi metallo-β-lactamase variant 1 (NDM-1)–encoding Escherichia coli sequence type (ST) 101 isolates have been detected worldwide. Stars indicate countries where NDM-encoding E. coli ST101 has been detected:...

Table

• Table. Resistance genes and plasmid profiles for a subset of Escherichia coli strains in a study of extensively drug-resistant New Delhi metallo-β-lactamase–encoding bacteria in the environment, Dhaka, Bangladesh, October 2012

Technical Appendix

• . Methods and Results for a study of extensively drug-resistant New Delhi metallo-β-lactamase–encoding bacteria in the environment, Dhaka, Bangladesh, October 2012; genomic location of NDM-1Escherichia coli  658 KB

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