title: Emergence of New Delhi metallo-β-lactamase 1 (NDM-1) producing and multidrug resistant uropathogens causing urinary tract infections in Andaman Islands, India.
abstract: The present study was undertaken to understand the distribution and the antimicrobial susceptibility patterns of the uropathogens in the remote islands of India. Patients' demographical data, urine culture results, and resistance rates were analyzed and multidrug resistant isolates were characterized. Significant bacteriuria was found in 16 (17.7%, 95% confidence interval [CI] 8.47-23.53%) samples, which includes Escherichia coli 9 (56.3%); Klebsiella pneumoniae 3 (18.8%); Enterobacter sp. 2 (12.5%) and Proteus mirabilis 2 (12.5%). The uropathogens showed a wide resistance involving 3-21 drugs with 15 different resistance patterns. Among the 16 isolates, 13 (81.3%, 95% CI 62.13-100.37%) and 11 (68.8%, 95% CI 46.04-91.46%) isolates were resistant to fluoroquinolones and third generation cephalosporins, respectively. Multiple mutations were detected in quinolone resistance determining region (QRDR) of the fluoroquinolone resistant isolates and all third generation cephalosporin resistant isolates producing extended-spectrum beta-lactamase. A total of 7 (44%, 95% CI 17.02-70.98%) isolates was found to harbor plasmid mediated quinolone resistance determinants The present study reports for the first time the presence of the New Delhi metallo-β-lactamase (NDM-1) gene in two isolates of P. mirabilis in these islands. Detection of multidrug resistant and NDM-1 producing isolates from cases of urinary tract infection in these remote islands lends support to the belief that the existence of these highly resistant strains is perhaps more widespread than previously thought and underscores the need for immediate implementation of antibiotic policy integrated with a continuous surveillance system. The study strengthens the need for a continuous surveillance system of antibiotic resistance in these remote Islands.
authors.affiliation: 1 Department of Health, Ministry of Health and Family, Regional Medical Research Centre (Indian Council of Medical Research) , Port Blair, India .
authors.forename: Debdutta
authors.initials: D
authors.lastname: Bhattacharya
authors.forename: Ramanathan
authors.initials: R
authors.lastname: Thamizhmani
authors.forename: Haimanti
authors.initials: H
authors.lastname: Bhattacharya
authors.forename: Devarajan Sudharama
authors.initials: DS
authors.lastname: Sayi
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Muruganandam
authors.forename: Subarna
authors.initials: S
authors.lastname: Roy
authors.forename: Attayur Purushothaman
authors.initials: AP
authors.lastname: Sugunan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004754:Enterobacter / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D062665:Epidemiological Monitoring; D004926:Escherichia coli / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D007194:India / Q000453:epidemiology; D062312:Islands; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010957:Plasmids; D011513:Proteus mirabilis / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D001618:beta-Lactamases; C552864:beta-lactamase NDM-1