Abstract
The rapidity with which new types of antibiotic resistance can disseminate globally following their initial emergence or recognition is exemplified by the novel carbapenemase New Delhi metallo-β-lactamase (NDM). The first documented case of infection caused by bacteria producing NDM occurred in 2008, although retrospective analyses of stored cultures have identified the gene encoding this enzyme (blaNDM) in Enterobacteriaceae isolated in 2006. Since its first description, NDM carbapenemase has been reported from 40 countries worldwide, encompassing all continents except South America and Antarctica. The spread of NDM has a complex epidemiology involving the spread of a variety of species of NDM-positive bacteria and the inter-strain, inter-species and inter-genus transmission of diverse plasmids containing blaNDM, with the latter mechanism having played a more prominent role to date. The spread of NDM illustrates that antibiotic resistance is a public health problem that transcends national borders and will require international cooperation between health authorities if it is to be controlled.
Highlights
The ability of influenza virus to spread globally has long been recognized, with several pandemics having been recorded over the last 100 years
This issue remains the subject of contention, but what can undoubtedly be said for the present is that, irrespective of their origin, New Delhi metallo b-lactamase (NDM)-positive bacteria pose a significant public health threat in both the Indian subcontinent and the Balkans, with such strains being onwardly disseminated to diverse geographical regions around the globe
In terms of the initial emergence of NDM in human pathogens, it has been hypothesized that the blaNDM–bleMBL pairing may have been integrated first into the chromosome of Acinetobacter baumannii from an unknown environmental species, where it became associated with ISAba125, and was transposed onto plasmids capable of replication and conjugative transfer in Enterobacteriaceae, with the downstream copy and most of the upstream copy of ISAba125 subsequently being lost from some isolates (Nordmann et al, 2012b)
Summary
The ability of influenza virus to spread globally has long been recognized, with several pandemics having been recorded over the last 100 years. There is increasing appreciation that influenza virus is not unique and that many other pathogens are transmitted internationally, including bacteria that are resistant to antibiotics. The global dissemination of antibiotic-resistant bacteria has received much attention, over the last 100 years, following reports of the international spread of multi-resistant Streptococcus pneumoniae (Munoz et al, 1991), meticillin-resistant Staphylococcus aureus (Johnson, 2011; Stefani et al, 2012) and resistant Enterobacteriaceae, strains resistant to cephalosporins due to the production of CTX-M type extended-spectrum b-lactamases and strains producing carbapenemases such as KPC (van der Bij & Pitout, 2012). As a more current and pressing example of the rapidity with which a newly emergent type of antibiotic resistance can disseminate globally following its initial description, this article will focus on the problem of carbapenem resistance mediated by New Delhi metallo b-lactamase (NDM), a carbapenemase first reported in 2008 (Yong et al, 2009)
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