First case of New Delhi metallo-beta-lactamase 1-producing Escherichia coli infection in Japan.

To the Editor—Emergence of multidrug-resistant organisms is a threat to public health, because there is limited effort devoted to the development of new antibiotics [1]. Multiple new mechanisms of resistance have been described recently, including a new type of carbapenem resistance gene, blaNDM-1, reported in 2009 [2]. Infections due to strains with blaNDM-1 have been reported in India, Pakistan, the United Kingdom, and the United States [2–4]. We report the first case, to our knowledge, of New Delhi metallo-blactamase 1 (NDM-1)–producing Escherichia coli infection in Japan. A 54-year-old Japanese man traveled to India for business in March 2009. During his trip, he developed dysarthria, blurring of his left eye, and tingling in his right upper extremity. He was admitted to a local hospital in India on 25 March 2009 with a diagnosis of Guillain–Barre syndrome, and he subsequently developed bradycardia, hypotension, and respiratory failure. He was intubated and received mechanical ventilation. Once he was deemed stable enough to travel with mechanical ventilation, he was transferred to the intensive care unit at Dokkyo Medical University Hospital in Japan on 4 April 2009. One month after the transfer, the patient developed fever, and 2 sets of blood cultures showed 2 types of E. coli simultaneously. One isolate was an extended-spectrum b lactamase (ESBL)