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The increasing incidence of infections caused by NDM-1-producing Enterobacteriaceae is a major concern to the international medical community, as such strains may display resistance to many, if not all, available antibiotics. Although there is much evidence to suggest that NDM-1-producing organisms are widespread in the population of the Indian subcontinent, reports on the emergence of these organisms have come from geographically diverse regions of the globe including Asia, Australia, the Far East, the USA, Canada, the Middle East and many countries in Europe. Whilst the majority of the reports have confirmed isolation of NDM-1-producing organisms from clinical specimens, faecal carriage of these organisms has rarely been reported. Recently, Johnson & Woodford (2013) published a review in this journal. Referring to our work and that of others, the authors mentioned that gut colonization was reported from Bangladesh and Pakistan (Islam et al., 2012; Perry et al., 2011): ‘In the Bangladesh study, screening of consecutive clinical samples over a 1-month period in late 2010 yielded 403 Gram-negative isolates, of which 14 (3.5 %) were positive for NDM-1.’ However, in our study we did not report gut colonization of NDM-1producing Enterobacteriaceae. The 3.5 % prevalence of NDM-1-producing organisms was found among all Gramnegative organisms isolated from clinical specimens, including endotracheal tube specimens, sputum, throat, tracheal aspirate, catheter tips, urine, pus and wound specimens. We did not include stool samples in our study, and thus gut colonization was not investigated. In a subsequent study, we tested a large number of Escherichia coli and Shigella spp. isolated from stool samples during 2007–2009 to detect the NDM-1 positives, but none of the isolates was positive (Islam et al., 2013). In Pakistan, however, a high prevalence (18.3 %) of faecal carriage of NDM-1-producing organisms has been reported (Perry et al., 2011). A separate study reported that NDM-1-producing Enterobacteriaceae can be found in patients from all major provinces of Pakistan and that chromID CARBA (bioMérieux) is a useful tool for the isolation of carbapenem-resistant organisms (Day et al., 2013). As we were not aware of similar data from Bangladesh, we carried out a study to determine the prevalence of faecal carriage of NDM-1-producing organisms among hospitalized patients with diarrhoea and outpatients attending Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in Bangladesh. Between September and October 2012, we collected 100 consecutive stool samples. Of these samples, 30 were collected from outpatients presenting at the outpatient services of icddr,b and 70 from patients with diarrhoea attending Dhaka hospital (hospital surveillance samples). We inoculated stool samples directly onto chromID CARBA agar plates using a sterile inoculation loop. The inoculated plates were incubated at 37 uC for 18–24 h. We observed the plates for bacterial growth and colony characteristics. In the case of heavy growth including colonies having a typical colony morphology (pink to burgundy/ bluish-green to bluish-grey), we randomly picked five colonies and subcultured these on MacConkey agar supplemented with meropenem (0.5 mg l). We extracted DNA from these colonies and performed a PCR specific for the NDM-1 gene (Islam et al., 2012). We identified the NDM-1-positive isolates using the API 20E system (bioMérieux).

Prevalence of faecal carriage of NDM-1-producing bacteria among patients with diarrhoea in Bangladesh