An enzyme associated with extensive antibiotic resistance called New Delhi metallo-ß-lactamase-1 (NDM-1), endemic in India and Pakistan and spreading worldwide, has been found in two people in the Toronto area, one of whom acquired it in Canada, states a case report in CMAJ (Canadian Medical Association Journal). The report outlines challenges and approaches to managing and identifying this pathogen, which is highly resistant to treatment.
NDM-1 has spread because of worldwide travel, medical tourism and its ability to transfer between bacteria.
In one of the cases in this report, the patient had not travelled outside southwestern Ontario in over a decade, and no source could be identified for the organism. In the other case, the patient had been hospitalized in India for a medical procedure and acquired the organism there.
"These two scenarios show that local acquisition of an organism producing NDM-1 has already occurred in Ontario, Canada, that blaNDM-1 has been found in bacterial species other than [Escherichia coli] and [Klebsiella pneumoniae], that treatment options are limited for infections with NDM-1-producing organisms, and that the detection of NDM-1-producing organisms by a laboratory can be difficult," writes Dr. Susan Poutanen, Mount Sinai Hospital and University Health Network, with coauthors.
NDM-1 has spread because of worldwide travel, medical tourism and its ability to transfer between bacteria.
In one of the cases in this report, the patient had not travelled outside southwestern Ontario in over a decade, and no source could be identified for the organism. In the other case, the patient had been hospitalized in India for a medical procedure and acquired the organism there.
"These two scenarios show that local acquisition of an organism producing NDM-1 has already occurred in Ontario, Canada, that blaNDM-1 has been found in bacterial species other than [Escherichia coli] and [Klebsiella pneumoniae], that treatment options are limited for infections with NDM-1-producing organisms, and that the detection of NDM-1-producing organisms by a laboratory can be difficult," writes Dr. Susan Poutanen, Mount Sinai Hospital and University Health Network, with coauthors.
