New Delhi metallo- -lactamase-1 in Enterobacteriaceae: emerging resistance

Let us consider the following hypothetical scenario. A 48-year-old man with a history of type 2 diabetes mellitus was recently on vacation in Calcutta, India. Three days into his stay, he was involved in a motor vehicle accident, for which he was admitted to the local general hospital. He underwent open reduction and internal fixation of a comminuted fracture of the left tibia. His postoperative care was unremarkable except for a urinary tract infection. He was given cefazolin intravenously for five days. After 12 days in hospital, he was discharged and was assessed by an orthopedic surgeon upon his return to Canada. Radiographic examination showed loosening of the prosthetic hardware. He was admitted to hospital for revision of the hardware. Intraoperative cultures grew Klebsiella pneumoniae that showed resistance to -lactam antibiotics, fluoroquinolones, cephalosporins and carbapenems. A modified Hodge test to detect carbapenemase gave a positive result. The isolate was forwarded to the local public health laboratory, where the presence of the gene for New Delhi metallo--lactamase-1 (NDM-1) was confirmed by polymerase chain reaction and DNA sequencing.