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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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The best treatment for an infection caused by bacteria that make NDM-1 is to determine which antibiotics the NDM-1 strain is susceptible (not resistant) to and use those antibiotics for patient treatment. One antibiotic, colistin, which is infrequently used because of its toxicity, is often the only antibiotic to which NDM-1-producing bacteria are susceptible. However, some NDM-1-producing bacteria have shown sensitivity to tigecycline (Tygacil) and a few to aztreonam (Azactam). However, these antibiotics should not be used without first determining the resistance/susceptibility pattern for the individual infecting bacterial strain. Antibiotic resistance/susceptibility patterns for bacteria are routinely done in labs that grow isolated bacterial strains in the presence of antibiotic-impregnated disks; resistant bacteria grow up to the disk edge, while bacteria susceptible to being inhibited or killed by the antibiotic leave a clear space of no growth that extends away from the disk edge. The larger the clear space, the more susceptible is the bacterial strain to the antibiotic (see example, Figure 2). Most NDM-1-producing bacteria show no clear space. One problem with this test is that it takes about two days to get results.

Figure 2. Kirby-Bauer disk test for antibiotic resistance/susceptibility pattern. SOURCE: CDC/Gilda L. Jones

Researchers at GlaxoSmithKline have identified a new antibiotic compound that may inhibit bacterial topoisomerase function in NDM-1-containing bacteria. Consequently, the bacterial replication (growth) is inhibited or stopped. Unfortunately, the compound has not gone through any clinical trials and is not likely to be commercially available very soon, since no clinical trials are currently scheduled.

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