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New Delhi metallo-β-lactamase (NDM-1) is a known enzyme that causes bacteria resistance against a large range of β-lactam antibiotic drugs. β-lactam antibiotics act by inhibiting the synthesis of cell wall layers and because the bacteria are unable to form cell walls they undergo lysis [1]. NDM-1, however, hydrolyzes the amide bond and inactivates the β-lactam antibiotics and allows the bacterial infections to thrive [2].

NDM-1 refers to a transmissible genetic element encoding multiple resistance genes. The gene from NDM-1 is capable of spreading from one strain of bacteria to a different strain through the use of horizontal gene transfer [3]. The initial strain, was isolated from a strain of Klebsiella pneumoniae that was obtained from a Swedish patient who acquired a urinary tract infection while traveling in New Delhi, India in 2008 [4]. Consequently, NDM-1has been found in organisms containing the genetic element throughout India, Pakistan, Bangladesh, the United Kingdom [5], Japan [6], and the United States.

Function

New Delhi metallo- β -lactamase 1 has the capability of making bacteria resistant to a variety of β-lactam antibiotics, including the mainstay antibiotics that can treat antibiotic-resistant bacterial infections. These mainstay antibiotics include the carbapenem family antibiotics which are extremely powerful drugs that can fight highly resistant bacteria [1]. Carbapenems work by inhibiting the synthesis of cell wall layers in bacteria. The gene, blaNDM-1, produces NDM-1 (a carbapenemase beta-lactamase) that can hydrolyze and inactivate the carbapenem antibiotics [7]. The resistance that blaNDM-1 confers, aids in the expansion of the bacteria that carries the gene throughout the human host.

Spread

NDM-1 was discovered to have originated in India [4]. The enzyme has been found in different water sources throughout India [8]. New Delhi metallo- β -lactamase 1has since spread to other countries by people who have spent some amount of time in India [8]. NDM-1 has confirmed cases in Australia, Japan, the United Kingdom, the United States, as well as a few other places [5].

NDM-1’s genetic code is able to spread from one bacteria strain to another through the use of horizontal gene transfer [3]. This is a major concern because the new antibiotic-resistant infections could immerge from the NDM-1 enzyme and become untreatable.

Currently, patients who have obtained the New Delhi metallo- β -lactamase 1 enzyme are treated on a case-by-case basis with different combinations of medications. The only way to fight the spread of NDM-1 is through quick identification, isolation, disinfection, and proper hygiene.

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