New Delhi metallo-β-lactamase-1 is a bacterial enzyme that renders all current β-lactam antibiotics inactive. Most patients from whom an NDM-1–producing ...NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutTryoutPMCLabsandtelluswhatyouthink.LearnMore.JournalListCMAJv.183(1);2011Jan11PMC3017254CMAJ.2011Jan11;183(1):59–64.doi: 10.1503/cmaj.101487PMCID:PMC3017254PMID:21220461NewDelhimetallo-β-lactamase-1inEnterobacteriaceae:emergingresistanceDylanR.Pillai,MDPhD,AllisonMcGeer,MD,andDonaldE.Low,MDAuthorinformationCopyrightandLicenseinformationDisclaimerFromtheDepartmentofMicrobiology(Pillai,McGeerandLow),MountSinaiHospital,Toronto,Ont.;theOntarioAgencyforHealthProtectionandPromotion,Toronto,Ont.;andtheDepartmentofLaboratoryMedicineandPathobiology,UniversityofToronto,Toronto,Ont.Correspondenceto:Dr.DonaldE.Low,ac.no.ianistm@woldCopyright©1995-2011,CanadianMedicalAssociationThisarticlehasbeencitedbyotherarticlesinPMC.Letusconsiderthefollowinghypotheticalscenario.A48-year-oldmanwithahistoryoftype2diabetesmellituswasrecentlyonvacationinCalcutta,India.Threedaysintohisstay,hewasinvolvedinamotorvehicleaccident,forwhichhewasadmittedtothelocalgeneralhospital.Heunderwentopenreductionandinternalfixationofacomminutedfractureofthelefttibia.Hispostoperativecarewasunremarkableexceptforaurinarytractinfection.Hewasgivencefazolinintravenouslyforfivedays.After12daysinhospital,hewasdischargedandwasassessedbyanorthopedicsurgeonuponhisreturntoCanada.Radiographicexaminationshowedlooseningoftheprosthetichardware.Hewasadmittedtohospitalforrevisionofthehardware.IntraoperativeculturesgrewKlebsiellapneumoniaethatshowedresistancetoβ-lactamantibiotics,fluoroquinolones,cephalosporinsandcarbapenems.AmodifiedHodgetesttodetectcarbapenemasegaveapositiveresult.Theisolatewasforwardedtothelocalpublichealthlaboratory,wherethepresenceofthegeneforNewDelhimetallo-β-lactamase-1(NDM-1)wasconfirmedbypolymerasechainreactionandDNAsequencing.Thecarbapenemclassofantimicrobia