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Medical Author:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Although it is standard practice to test all bacteria isolated from an infected patient, some hospitals may not test for carbapenem resistance because resistance to it is relatively infrequent in most industrialized countries currently. Although this situation may change quickly, if gram-negative isolates show resistance to penicillins, they probably should be tested for carbapenem resistance. If the patient is known to travel to areas where NDM-1 is frequently found (India, Pakistan), the isolated gram-negative bacteria should be immediately tested for carbapenem resistance. This test, however, does not determine that the infecting bacteria possess NDM-1 because there are a few other enzymes (for example, Klebsiella pneumoniae carbapenemase also termed KPC) that can cause resistance to carbapenems, but they are not as effective as NDM-1. If a carbapenem-resistant bacterial strain is recovered from a patient, the bacteria should be sent to a state public-health laboratory or the U.S. Centers for Disease Control and Prevention (CDC) for specific testing for NDM-1, because testing for NDM-1 is not routinely available. Patients who have bacteria isolated from their infective site that have detectable NDM-1 by the state or CDC facilities are then definitively diagnosed as having an infection caused by bacteria that produce NDM-1.

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