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NDM-1 (cont.)

What Are Symptoms and Signs of a Person Infected With Bacteria Carrying NDM-1?

The major sign or symptom that a person is infected with bacteria carrying NDM-1 is failure of antibiotic treatments (oral or IV) to improve the patient's condition, especially if the patient is infected with a gram-negative bacterial type and is being treated with an antibiotic that contains a beta-lactam ring structure. In addition, if the person has gone to another country (for example, India) for elective surgery or was recently treated with antibiotics for an infection and has returned to the U.S. or another industrialized country with the infection, caregivers should be suspicious that a bacteria producing NDM-1 may be causing the infection. Currently, these are the major clues to suggest infection with NDM-1.

Because NDM-1 can be carried by several types of gram-negative bacteria, the signs and symptoms of the diseases are of little or no help in distinguishing whether the patient has an organism expressing the enzyme until antibiotic treatments fail. However, because gram-negative bacteria are known to cause many diseases (for example, gastrointestinal problems, urinary tract infections, pneumonia, and some wound infections), patients with these diseases that require antibiotic treatments and are not recovering appropriately with treatments should have the gram-negative bacteria isolated and tested for antibiotic resistance.

When to Seek Medical Care for Infections by Bacteria Carrying NDM-1

Any person who has been diagnosed with an infection caused by NDM-1 and still has symptoms of the infection needs to seek medical care, even if they are taking antibiotics. Currently, most people diagnosed with NDM-1 bacterial infections are hospitalized, but some people are discharged and sent home, often with "home" being in another country. These people should seek medical care immediately to prevent further spread of the infection. In addition, any person who develops an infection with gram-negative bacteria who has had any close contact with someone known to have NDM-1 bacteria, both as an infection or as a carrier, should seek medical care and inform the caregiver of their potential association with NDM-1 bacteria.

How Are Bacteria That Produce NDM-1 Identified?

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.

Medically Reviewed by a Doctor on 7/7/2016

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