New Delhi metallo-beta-lactamase-1

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This editable Main Article is under development and subject to a disclaimer.

[edit intro]

New Delhi metallo-beta-lactamase-1 enzyme confers bacterial resistance to antibiotics of the carbepenem class, often considered "last resort" drugs for multidrug resistant bacteria.[1] The gene to manufacture it can be horizontally transferred among different species of pathogenic bacteria. In September 2010, news media have been reporting bacteria with this resistance as a new "superbug".

Organisms that produce the enzyme are resistant to virtually all beta-lactam antibiotics except aztreonam. [2] These organisms often are also resistant to fluoroquinolones and aminoglycosides.

First reported in Klebsiella pneumoniae, it has been reported in Acinetobacter, Escherichia coli, Citrobacter freundii, Enterobacter cloacae, and Morganella morganii. A number of cases have been found in Britain, Canada and the US in patients that went to India for medical procedures or were treated for emergencies while in India.[3]

## Contents

* 1 Clinical management
* 2 Indian response
* 3 The Lancet apology and aftermath
* 4 References

## Clinical management[edit]

"For all acute care facilities, the Centers for Disease Control and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend an aggressive infection control strategy, including managing all patients with carbepenem-resistant enterobacteriacease (CRE) using contact precautions and implementing Clinical and Laboratory Standards Institute (CLSI) guidelines for detection of carbapenemase production. In areas where CRE are not endemic, acute care facilities should

1. review microbiology records for the preceding 6--12 months to determine whether CRE have been recovered at the facility,
2. if the review finds previously unrecognized CRE, perform a point prevalence culture survey in high-risk units to look for other cases of CRE, and
3. perform active surveillance cultures of patients with epidemiologic links to persons from whom CRE have been recovered.

In areas where CRE are endemic, an increased likelihood exists for importation of CRE, and facilities should consider additional strategies to reduce rates of CRE. Acute care facilities should review these recommendations and implement appropriate strategies to limit the spread of these pathogens. " [4]

Antibiotics to be considered in treatment include tigecycline, colistin, polymyxin B, and aztreonam, as well as combination therapy.[1]

## Indian response[edit]

The Indian health ministry has disputed the conclusion of the August 2010 Lancet study that the gene originated in India, describing this conclusion as "unfair" and stating that Indian hospitals are perfectly safe for treatment.[5][6] Indian politicians have described linking this new drug resistance gene to India as "malicious propaganda" and blamed multinational corporations for what they describe as selective malignancy.[5][7] A Bharatiya Janata Party politician has instead argued that the journal article is bogus and represented an attempt to scare medical tourists away from India.[8] The Indian Ministry of Health released a statement "strongly refut[ing]" naming the enzyme "New Delhi".[9] A co-author of the 2010 Lancet study, who is based in the University of Madras, has stated that he does not agree with the part of the article that advises people to avoid elective surgeries in India.[10]

In contrast, an editorial in the March 2010 issue of the Journal of Association of Physicians of India blamed the emergence of this gene on the widespread misuse of antibiotics in the Indian healthcare system, stating that Indian doctors have "not yet taken the issue of antibiotic resistance seriously" and noting little control over the prescription of antibiotics by doctors and even pharmacists.[11] The Times of India states that there is general agreement among experts that India needs both an improved policy to control the use of antibiotics and a central registry of antibiotic-resistant infections.[10]

## The Lancet apology and aftermath[edit]

The British Journal 'The Lancet' refused to publish rebuttal from Indian National Centre for Disease Control, claiming lack of space and that editors' decision was that it was better placed elsewhere.[12]

On 12 January 2011, the editor of The Lancet, Richard Horton, apologized and acknowledged that naming a superbug after New Delhi was an “error”.[13] Following this, Ajai R. Singh, editor of Mens Sana Monographs, demanded that such 'geographic names giving' be abandoned and replaced by 'scientific names giving'. He proposed changing NDM-1 to PCM Plasmid-encoding Carbapenem-resistant Metallo-beta-Lactamase.[14]

## References[edit]

1. ↑ 1.0 1.1 Krishna B (2010 [cited 2010 Sep 14]), "New Delhi metallo-beta-lactamases: A wake-up call for microbiologists", Indian J Med Microbiol [serial online] 28: 265-6.
2. ↑ Nordmann P, Poirel L. (2002), "Emerging carbapenemases in Gram-negative aerobes", Clin Microbiol Infect 8: 321-31
3. ↑ "NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan (02)", ProMED Emerging Disease Report, International Society for Infectious Diseases, 14 September 2010
4. ↑ Centers for Disease Control and the Healthcare Infection Control Practices Advisory Committee (HICPAC) (20 March 2009), "Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities", Morbidity and Mortality Weekly Report 58 (10): 256-260
5. ↑ 5.0 5.1 Pandey, Geeta. India rejects UK scientists' 'superbug' claim, BBC News, 12 August 2010. Retrieved on 13 August 2010.
6. ↑ Telegraph.co.uk: Indian Government angry over claims its hospitals are fuelling global superbug
7. ↑ Linking India to superbug unfair and wrong, says India, Hindustan Times, 12 August 2010. Retrieved on 13 August 2010.
8. ↑ 'Superbug' an MNC conspiracy: BJP leader | SS Ahluwalia | superbug | Indian Express
9. ↑ Sharma, Sanchita. 'Don't blame superbug on India, it's everywhere', Hindustan Times, 13 August 2010. Retrieved on 13 August 2010.
10. ↑ 10.0 10.1 Narayan, Pushpa. Indian author says superbug report is fudged, The Times of India, 13 August 2010. Retrieved on 13 August 2010.
11. ↑ Abdul Ghafur K (March 2010). "An obituary- On the Death of antibiotics!". Journal of Association of Physicians of India 58.
12. ↑ Lancet won't publish India's rebuttal, NEW DELHI, Special Correspondent, April 13 2011, thehindu.com
13. ↑ Lancet says sorry for 'Delhi bug', The Times Of India, 12 January 2011. Retrieved on 2011-01-12.
14. ↑ Science, names giving and names calling: Change NDM-1 to PCM. Mens Sana Monographs. Retrieved on 2011-03-11.