NDM-1 Has Arrived: First Report of a Carbapenem Resistance Mechanism in South Africa (Scientific Letter) (Carbapenemase) (Letter to the Editor) (Report‪)‬

To the Editor: Resistance to [beta]-lactam antibiotics in Enterobacteriaceae has steadily increased, with the emergence of carbapenem-resistant Enterobacteriaceae (CRE) seen in the past decade. Resistance to carbapenems may be mediated via a variety of mechanisms, but the development and spread of carbapenemases ([beta]-lactamase enzymes that hydrolyse carbapenems and many other [beta]-lactam antibiotics) in Enterobacteriaceae has caused global concern. One such carbapenemase, NDM-1 (New Delhi metallo-[beta]-lactamase), first described in 2009, (1) has rapidly emerged as the leading threat to the treatment of infections caused by Enterobacteriaceae. A Swedish patient of Indian origin, who travelled to New Delhi in 2007, developed an infection caused by a strain of Klebsiella pneumoniae harbouring the [bla.sub.NDM-1] gene encoding NDM-1. A subsequent study demonstrated that NDM-1-positive isolates were already present in Indian hospitals in 2006. (2) Dissemination of NDM-1-positive bacteria in the environment and community-acquired infection with these resistant organisms in parts of India is well-documented. (3,4) Enterobacteriaceae with NDM-1 have since been isolated from patients in the USA, Canada, UK, Europe, Australia, Oman, Japan, Singapore and Africa. (5-7) The presence of NDM-1 was demonstrated in certain multi-drug resistant (MDR) K. pneumoniae isolates from a Kenyan hospital, in strains archived over a 3-year period (2007-2009). (5)