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Travel Med Infect Dis. 2015 Jul-Aug;13(4):295-9. doi: 10.1016/j.tmaid.2015.06.003. Epub 2015 Jun 24.

A passage from India: Association between air traffic and reported cases of New Delhi Metallo-beta-lactamase 1 from 2007 to 2012.

Author information

1
Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada. Electronic address: derek.macfadden@mail.utoronto.ca.
2
Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada.
3
Boston Children's Hospital, Boston, MA, United States.
4
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
5
Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Highly transmissible genes encoding resistance to carbapenems have demonstrated global spread. The New Delhi Metallo-beta-lactamase 1 gene is hypothesized to have originated in India, with subsequent dissemination by colonized or infected travelers.

METHOD:

We conducted an ecological study evaluating the association between the cumulative air traffic departing India between 2007 and 2012 and published cases of NDM-1. Receiver operator characteristic curves were generated as well as multivariate logistic regression models. 193 countries with complete flight and World Bank data were included in the analysis.

RESULTS:

Receiver operator characteristic curves (ROC) of the dichotomous outcome of a published case of NDM-1 were generated, yielding an unadjusted area under the curve (AUC) of 0.88 and adjusted AUC of 0.85. The unadjusted odds ratio of having a reported case of NDM-1, for every percentage increase in cumulative air traffic departing India, was 2.3 (95% CI 1.4 to 3.7) and adjusted was 2.0 (95% CI 1.2 to 3.4).

CONCLUSIONS:

We demonstrate that flows of international travelers departing India by air is associated with published NDM-1 cases, globally. Countries with high passenger flight traffic from India with no reported cases of NDM-1 may be at increased risk of having unreported transmission of NDM-1.

KEYWORDS:

Air travel; Antimicrobial resistance; New Delhi Metallo-beta-lactamase

PMID:
26143595
DOI:
10.1016/j.tmaid.2015.06.003
[Indexed for MEDLINE]

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