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Vol 10 September 2010 597 Articles Lancet Infect Dis 2010; 10: 597–602 Published Online August 11, 2010 DOI:10.1016/S1473- 3099(10)70143-2 See Reflection and Reaction page 578 Department of Microbiology, Dr ALM PG IBMS, University of Madras, Chennai, India (K K Kumarasamy MPhil, P Krishnan PhD) ; Department of Infection, Immunity and Biochemistry, School of Medicine, Cardiff University, Cardiff, UK (M A Toleman PhD, Prof T R Walsh PhD) ; Health Protection Agency Centre for Infections, London, UK (J Bagaria MD, R Balakrishnan MD, M Doumith PhD, S Maharjan MD, S Mushtaq MD, T Noorie MD, A Pearson PhD, C Perry PhD, R Pike PhD, B Rao MD, E Sheridan PhD, J Turton PhD, M Warner PhD, W Welfare PhD, D M Livermore PhD, N Woodford PhD) ; Department of Microbiology, Shaukat Khanum Cancer Hospital, Lahore, Pakistan (F Butt MD) ; Department of Microbiology, Pandit B D Sharma PG Institute of Medical Sciences, Haryana, India (U Chaudhary MD, M Sharma MD) ; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden (C G Giske MD) ; Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan (S Irfan MD) ; Department of Microbiology, Amrita Institute of Medical Sciences, Kerala, India (A V Kumar MD) ; University of Queensland Centre for Clinical Research, University of Brisbane, Herston, QLD, Australia (D L Paterson MD) ; Department of Microbiology, Apollo Gleneagles Hospital, Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study Karthikeyan K Kumarasamy, Mark A Toleman, Timothy R Walsh, Jay Bagaria, Fafhana Butt, Ravikumar Balakrishnan, Uma Chaudhary, Michel Doumith, Christian G Giske, Seema Irfan, Padma Krishnan, Anil V Kumar, Sunil Maharjan, Shazad Mushtaq, Tabassum Noorie, David L Paterson, Andrew Pearson, Claire Perry, Rachel Pike, Bhargavi Rao, Ujjwayini Ray, Jayanta B Sarma, Madhu Sharma, Elizabeth Sheridan, Mandayam A Thirunarayan, Jane Turton, Supriya Upadhyay, Marina Warner, William Welfare, David M Livermore, Neil Woodford Summary Background Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β- lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK. Methods Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK’s national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene bla NDM-1 was established by PCR. Isolates were typed by pulsed-fi eld gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan.
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