Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study.
Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study.
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DOI：
10.1016/s1473-3099(10)70143-2
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发表时间：
2010-09
期刊：
影响因子：
--
通讯作者：
Woodford N
中科院分区：
文献类型：
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作者：
Kumarasamy KK;Toleman MA;Walsh TR;Bagaria J;Butt F;Balakrishnan R;Chaudhary U;Doumith M;Giske CG;Irfan S;Krishnan P;Kumar AV;Maharjan S;Mushtaq S;Noorie T;Paterson DL;Pearson A;Perry C;Pike R;Rao B;Ray U;Sarma JB;Sharma M;Sheridan E;Thirunarayan MA;Turton J;Upadhyay S;Warner M;Welfare W;Livermore DM;Woodford N
由新德里金属β-内酰胺酶1（NDM-1）引起的对碳青霉烯类耐药的革兰氏阴性肠杆菌科细菌是潜在的全球主要健康问题。我们调查了印度、巴基斯坦和英国多重耐药肠杆菌科中NDM-1的患病率。对印度两个主要中心--钦奈（印度南部）和哈里亚纳邦（印度北部）--以及英国国家参考实验室的肠杆菌科菌株进行了研究。评估抗生素敏感性，并通过PCR确定碳青霉烯耐药基因blaNDM-1的存在。通过XbaI限制性基因组DNA的脉冲场凝胶电泳对分离株进行分型。质粒DNA经S1酶切和PCR分型。对英国患者的病例数据进行了审查，以获得旅行和最近在印度或巴基斯坦住院的证据。我们在钦奈、哈里亚纳邦、英国和印度和巴基斯坦的其他地点分别鉴定出44株、26株、37株和73株NDM-1。NDM-1主要存在于大肠埃希菌（36株）和肺炎克雷伯菌（111株）中，这两株菌对除替加环素和粘菌素外的所有抗生素均高度耐药。来自哈里亚纳邦的肺炎克雷伯菌分离株是克隆的，但来自英国和钦奈的NDM-1生产者是克隆多样的。大多数分离株携带质粒上的NDM-1基因：来自英国和钦奈的分离株容易转移，而来自哈里亚纳邦的分离株不接合。许多英国NDM-1阳性患者在过去一年内曾前往印度或巴基斯坦，或与这些国家有联系。NDM-1成为全球公共卫生问题的可能性很大，需要协调的国际监测。欧盟、惠康信托和惠氏。
Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene blaNDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan. We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries. The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed. European Union, Wellcome Trust, and Wyeth.