Microbiology: A Systems Approach 4th Edition by Marjorie Kelly Cowan

Exercise 5

World Travel, Antibiotic Resistance, and Political Discord
In May 2011, a woman from Rhode Island visited her native Cambodia. While she was there, she was treated for spinal cord compression in Ho Chi Minh City, Vietnam. During her stay in the hospital, she developed a urinary tract infection due to a long-term indwelling catheter and was prescribed antibiotics for treatment. Upon returning home to Rhode Island in January of 2012, she was immediately hospitalized and diagnosed with lymphoma. Her cancer treatment required her to again be catheterized, and subsequently she developed another urinary tract infection. When the infection did not respond to the normal course of antibiotic treatments, culturing of urine specimens revealed the growth of a unique drug-resistant strain of Klebsiella pneumoniae.
Given the woman's recent travel history, the isolate was sent to the Centers for Disease Control and Prevention (CDC) for further testing. The CDC confirmed that the patient was harboring a strain of bacterium known as carbapenem-resistant Enterobacteriaceae (CRE). This particular strain of K. pneumoniae, however, contained a gene ( bla NDM-1 ) encoding an enzyme called New Dehli metallo-beta-lactamase 1 (NDM-1), which confers resistance to 24 different antibiotics. Because the organism was highly resistant to antibiotics, the patient was placed on isolation precautions during her stay in the hospital; she was discharged on March 26, 2012. On March 30, a rectal swab taken from one of seven individuals treated in the same unit was positive for K. pneumoniae. Further testing revealed that it was genetically identical to the CRE NDM-1 strain found initially in the discharged patient, indicating that this bacterium had somehow spread within the unit. Hospital records showed that although no physicians or nurse practitioners were in contact with both patients during their stay, there were 23 nurses that had cared for both patients.
What is New Delhi metallo-beta-lactamase 1 (NDM-1)
How is the gene for this enzyme spread among bacteria
New Delhi metallo-beta-lactamase 1 (NDM-1) is a plasmid-encoded enzyme capable of breaking the beta-lactam ring of many antibiotics, including the carbapenem family, an important group of drugs traditionally used in the treatment of penicillin-resistant bacterial infections. This unique beta-lactamase and the gene that codes for it, bla NDM-1 , were first discovered in 2008 in people who had traveled to India or South Asia. Since then, cases have been found in Belgium, Canada, China, Japan, Oman, Pakistan, and Singapore, but all cases have involved individuals who have traveled to South Asia.
The bla NDM-1 gene is easily transmitted from bacterium to bacterium through horizontal gene transfer and has been found in Shigella boydii , Vibrio cholerae , Escherichia coli , and other members of the Enterobacteriaceae family. These organisms are exceptionally good at surviving on environmental surfaces such as hospital bed rails, IV poles, floors, and computer keyboards, making the probability of patient-to-patient transmission or transmission via hospital staff likely.
How did NDM-1 develop
How did the Indian government react to the announcement of the development of NDM-1