Treatment options for New Delhi metallo-beta-lactamase-harboring enterobacteriaceae

Microb Drug Resist. 2013 Apr;19(2):100-3. doi: 10.1089/mdr.2012.0063. Epub 2013 Jan 18.

Abstract

The New Delhi metallo-β-lactamase gene (bla(NDM-1)) has emerged as a worldwide concern among isolates of Enterobacteriaceae. Its epidemiology is been strongly associated with travel and healthcare on the Indian Subcontinent. We report two cases of urinary tract infection with Enterobacteriaceae harboring a bla(NDM-1). Both cases presented as infection in community-dwelling individuals in Australia and were associated with travel to the Indian Subcontinent. One isolate of Escherichia coli harbored the previously undescribed enzyme variant bla(NDM-3), differing from bla(NDM-1) by a single nonsynonymous SNP conferring a putative peptide sequence change at the 95th position (ASP→ASN). The second was an Enterobacter cloacae harboring bla(NDM-1). Further genetic characterization included identification of additional β-lactamase and aminoglycoside resistance genes. Legacy antimicrobials were used for treatment. Oral therapy with nitrofurantoin was successful in one case, while combination of colistin and rifampicin was required in the second patient. Such infection, due to extensively drug-resistant pathogens, poses significant challenges in balancing the efficacy and toxicity of potential antimicrobial therapies.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Colistin / therapeutic use
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Enterobacter cloacae / drug effects*
  • Enterobacter cloacae / enzymology
  • Enterobacter cloacae / genetics
  • Enterobacteriaceae Infections / drug therapy*
  • Enterobacteriaceae Infections / microbiology
  • Escherichia coli / drug effects*
  • Escherichia coli / enzymology
  • Escherichia coli / genetics
  • Female
  • Humans
  • Male
  • Nitrofurantoin / therapeutic use
  • Polymorphism, Single Nucleotide
  • Rifampin / therapeutic use
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / microbiology
  • beta-Lactamase Inhibitors
  • beta-Lactamases / genetics*
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • beta-Lactamase Inhibitors
  • Nitrofurantoin
  • beta-Lactamases
  • beta-lactamase NDM-1
  • Rifampin
  • Colistin