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New Delhi Metallo 1 (NDM 1) superbug
What is New Delhi Metallo 1 (NDM 1) superbug
New Delhi Metallo 1 (NDM 1) superbug is a resistant strain of
Enterobacteriaceae which includes bacteria like E.Coli, Klebsiella, Morganella
morganii etc. The resistant strain of Enterobacteriaceae New Delhi Metallo 1
(NDM 1) superbug is potentially dangerous. Health hazard of New Delhi
Metallo 1 (NDM 1) superbug is severe due to the fact that it is resistant against
all commonly used antibiotics espcially Carbapenem which is supposed to have
widest range of action against all Gram positive, Gram negative as well as
anaerobic bacteria. The reason of resistance of New Delhi Metallo 1 (NDM 1)
superbug is the presence of a gene (protein) New Delhi metallo-beta-lactamase
1 (NDM-1) which hydrolyzes carbapenem and inactivate them.
Figure (1) NDM 1 superbug structure
Diagnosis of New Delhi Metallo 1 (NDM 1) superbug infection
The diagnosis of New Delhi Metallo 1 (NDM 1) superbug infection depends
upon sign and symptoms and subsequent detection of New Delhi metallo-betalactamase 1 (NDM-1) in the bacteria cultured by taking different swabs. The
sign and symptoms of New Delhi Metallo 1 (NDM 1) superbug infection is
nothing different than those seen in Enterobacteriaceae infection. There may be
cough, urinary tract infection, fever. Patient may undergo in endotoxic shock in
severe infection.
In a research done at P.D.Hinduja National Hospital & Medical Research
Centre, Mumbai it has been detected that carbapenemase that is New Delhi
metallo-beta-lactamase 1 (NDM-1) has been detected in Klebsiella and most
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was diagnosed with urine samples. Few New Delhi metallo-beta-lactamase 1
(NDM-1) producing bacteria were also detected in sputum samples, blood
samples, tracheal secretions as well as bronchoalveolar lavage. The detection of
New Delhi metallo-beta-lactamase 1 (NDM-1) is usually done by Modified
Hodge test.
However in some cases New Delhi metallo-beta-lactamase 1 (NDM-1) cannot
be detected as the minimum inhibition concentration (MIC) of NDM 1 is below
the breakpoint. In such case a polymerase chain reaction (PCR) is required to
detect New Delhi metallo-beta-lactamase-1 or NDM-1.
Diagnostic Solutions for Carbapenemases and NDM-1
Biomerieux is actively committed to the fight against bacterial resistance and
offers a complete range of products for the detection and screening of the most
frequently found resistance mechanisms.
For carbapenemase-producing Enterobacteriaceae, and namely NDM-1, the
current Biomerieux solutions are:
♦Screening
chromID ESBL
•chromID ESBL– (20 plates) is a chromogenic medium for the Screening of
Extended Spectrum ß-Lactamase-producing Enterobacteriaceae (ESBL),
which have the capability to detect carbapenemase-producing
Enterobacteriaceae and also efficient for the detection of producers of
IMP/VIM and KPC-type carbapenemases.
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•Easier screening
chromID ESBL makes the screening of ESBL- and carbapenemase-producing
Enterobacteriaceae easier:
-faster reading (differentiated colouration of colonies)
-immediate and direct identification
-selective inhibition of Gram-positive bacteria and yeasts
-better specificity compared to conventional media and shorter time to result
(18-24 hour incubation) leading to less confirmation tests.
♦ Detection
•VITEK 2 – AST cards
Carbapenem resistance and carbapenemase production conferred by blaNDM-1 is
detected reliably with phenotypic testing methods currently in use in routine
laboratories including VITEK 2 and Etest.
-Since all routinely tested carbapenems are available on the VITEK 2 card,
carbapenem resistance can be detected in the course of routine testing.
-Advanced Expert System (AES) can reliably detect the carbapenemase
resistant phenotype.
NDM-1
- VITEK 2 and AES show 100% detection of NDM-1 with 7 isolates
tested.
- Good results for NDM, KPC and VIM strains.
- Data not yet published confirms good NDM-1 detection by VITEK 2
♦Etest MBL (IP/IPI)
This antimicrobial resistance detection strip is used for the detection
of MBL resistance. It can also detect NDM-1 in Enterobacteriaceae.
This is a phenotypic test that determines the presence of a MBL.
As with all the other Etest strips(30 pack & 100 pack): easy to use
and easy to interpret.
NDM-1
- The first known strain found in Sweden was detected by Etest
MBL (IP/IPI)
- A recent study on emergence of NDM-1 in Australia has shown
good detection of the resistance using Etest MBL
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Treatment of New Delhi Metallo 1 (NDM 1) superbug
There is not much scope left for treatment of New Delhi Metallo 1 (NDM 1)
superbug as the presence of New Delhi metallo-beta-lactamase 1 (NDM-1)
makes them resistance against almost all commonly used antibiotics especially
Carbapenem which is usually considered as the last resort in critical infections
and ICU patients.
Resistance to Carbepenem leads to limited therapeutic options for a patient
infected with New Delhi Metallo 1 (NDM 1) superbug. Few antiobics like
Colistin and Tigecycline has been tried with limited success. In few cases
combination of antibiotics has been tried with little success.
Figure (2) Carbapenem vial
How to Prevent New Delhi Metallo 1 (NDM 1) superbug
The most emphasis should be given to prevention and control of New Delhi
Metallo 1 (NDM 1) superbug. The preventive steps include stopping
indiscriminate and irrational use of antibiotics, to stop prescription free sale of
antibiotics which is mostly seen in Indian subcontinents. A careful selection of
antibiotics in each clinical condition drastically reduces the chance of
emergence of antibiotic resistance. A study revealed that out of 5 clinical
conditions having infections with Extended Spectrum Beta Lactamases
producing bacteria, 3 were cured without using Carbapenem.
Other most important mode of prevention of New Delhi Metallo 1 (NDM 1)
superbug infection is prevent this fast progressing disease from spreading by
being vigilant in our hygiene measures and by having an effective hand
washing. And as a rule of thumb, we need to strengthen our immune system by
eating plenty of fruits and vegetables, maintaining a healthy diet and taking
vitamins so we can have a strong shield against infections. This is required to
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do now for prevent us from acquiring this deadly disease as it has been told to
be antibiotics-resistant.
Another study report reveals that New Delhi Metallo 1 (NDM 1) superbug
infection is maximum spread via patients on ventilation, thus proper sanitation
of ICU, proper disposal of hospital wastes can be helpful in controlling
infection to a great extent.
While many more studies and researches are required and is going on to
establish more detailed facts about New Delhi Metallo 1 (NDM 1) superbug
infection, many pharmaceutical companies has already started to find out the
remedy for this. May be in recent years we may come up with new antibiotics
as an answer to this resistant case of Enterobacteriaceae having New Delhi
metallo-Beta-lactamase 1 (NDM-1) gene. ( figure 1)
Figure (3). metallo-Beta-lactamase 1 (NDM-1) gene
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NDM-1 Symptoms
Common symptoms
Urinary tract infections, RTI , blood infections and diarrhea
Figure (4) Sites of infection in human body with bacteria.
●NDM-1 Symptoms and Klebsiella Pneumoniae
One strain of bacteria linked to NDM-1 in the UK has been Klebsiella, )figure )
below a bacteria in the gut which contains the superbug NDM-1. Known as a
bacteria hosting NDM-1
Klebsiella pneumoniae symptoms include sudden onset, of high fever(can be
accompanied by dizziness and chills), cough (is also usually present with
sputum), upper respiratory tract infections, foul odor released from the nose,
congestion, wheezing, generalized skin infections, hemoptysis (currant jelly
sputum) and Bacteremia ,which means bacteria in the blood and may be
associated with blood infections. Generally there are no symptoms until the
amounts accumulate to the point of an infection in tissue or organs. Bacteremia
is most dangerous to those with low immune systems. Bacteremia can lead to
sepsis.
Klebsiella pneumoniae is a common gram-negative bacteria seen worldwide. It
is also known for causing urinary tract infections, nosocomial pneumonia, and
intraabdominal infections.
Figure (5) .colonies of Klebsiella pneumoniae in plate
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●E. Coli and NDM-1 Symptoms
NDM-1 is found in the E. Coli bacteria may be the cause of the cases which
show symptoms of urinary tract infections. E. Coli is the leading cause of
urinary tract infections outside of hospitals. Antibiotic-resistant E. Coli may
also be responsible for cases of fatal pneumonia and other infections. Diarrhea
watery or bloody (usually associated with pain and cramping in the abdomen),
nausea, vomiting and skin infections.
NDM-1 (New Delhi Metallo-beta-lactamase-1) is originated from bacteria
(Escheria coli or E. coli; Klebsiella pneumoniae, Enterobacter and Citrobacter,
the coliform gram-negative enteric bacilli). It is transmitted from person to
person by direct contact. It is originated from India, so the name is NDM-1. The
enzyme NDM-1 is found inside the coliform bacteria and makes the bacteria
extremely virulent and resistant to most antibiotics.
Basically, the symptoms will be related to the E. coli, the Klebsiella pneumonia,
Enterobacter and Citobacter, the gram-negative enteric bacilli.
Figure (6) Kirby-Bauer disk test for antibiotic resistance.
● Enterobac and NDM-1 Symptoms
Some symptoms of Enterobacter infections include bacteremia, lower
respiratory tract infections, skin infections, soft tissue infections, RTI, UTI,
fever, cough, production of purulent sputum, tachypnea, etc
● Citrobacter and NDM-1 Symptoms
Acute gastroenteritis is characterized by two or more of the symptoms of
vomiting, urinary tract infections include a burning sensation when urinating .
The symptoms you have will be in line with whatever it was that made you
sick. The real problem is that NDM-1 prevents doctors from treating that
bacteria with antibiotics.
NDM-1 doesn't raise your likelihood of getting sick; it just makes it much more
difficult to get better.
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The news is developing fast but it seems many who have been treated for
NDM-1 superbug are related to the symptoms of E. Coli. These can range from
urinary tract infections to bloody diarrhea. The diarrhea can be mild to begin
with or severe. Blood infections may also be a symptom.
The NDM-1 (New Delhi metallo-beta-lactamase) symptoms would be that of E.
coli and Klebsiella pneumonia. If this two combines, that makes NDM-1
resistant to even the most powerful antibiotics.
By
Supervisor
Abbas Sahib Al-Naffakh.
Dr. Mohammed Mahdi Al-Jawaheri
MSC. Med .Tech.
D. C. Pathology.
Laboratory Office.
Manager of Laboratory Office.
Dep of Technical Affairs.
Al-Najaf Health Directorate.
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