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Harrison's Principles of Internal Medicine, 18e
6/30/2011: NDM-1-Positive Bacteria Are Common in the Environment in New Delhi
Neeraj K. Surana
M.D., Ph.D., Fellow in Pediatric Infectious Diseases, Division of Infectious Diseases, Children's Hospital Boston, Boston, MA
Dennis L. Kasper
M.D., William Ellery Channing Professor of Medicine, Professor of Microbiology and Molecular Genetics, Harvard Medical School; Director, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston
Excerpt:"Ever since the clinical introduction of penicillin in 1946, antibiotic resistance has been a problem. This problem has worsened over the past two decades, with the development and increasing prevalence of multidrug-resistant bacteria. Although the carbapenem class of antibiotics was initially developed to eradicate organisms that express β-lactamase enzymes, gram-negative organisms have now developed carbapenemases, which can inactivate a wide range of antibiotics. The two most common carbapenemases are the Klebsiella pneumoniae carbapenemase (KPC) and the New Delhi metallo-β-lactamase 1 (NDM-1), which were first identified in 1996 and 2009, respectively. These carbapenemases can be transferred horizontally between species, and it has often been assumed that carbapenemase-producing strains are acquired in hospital settings. However, some patients with NDM-1-positive strains have had no prior contact with health care settings; where and how these patients acquired these strains has been unclear...."
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