NDM-1 and the Role of Travel in Its Dissemination

Antimicrobial resistance is a growing problem globally. The appearance and spread of bacteria that are resistant to most or all commonly available antibiotics has raised the specter of untreatable bacterial infections. The New Delhi metallo-beta-lactamase-1 (NDM-1) has received wide attention because of the extreme resistance it confers, its presence in many common pathogens, its rapid spread to multiple continents, and local nosocomial spread in some areas. Most early reports of infections were in individuals who had received medical care in the Indian subcontinent. This paper will explore the role of travelers in the movement of pathogens and microbial genetic material associated with resistance, with a special focus on the appearance and dispersal of bacteria carrying this mobile genetic element, bla(NDM-1), and the contributing factors, including growing long-distance travel and expansion of travel across international borders for medical, dental, and surgical care (medical tourism).