LESLEY CIARULA TAYLOR

STAFF REPORTER

Superbug NDM-1

At least two Canadians have been infected by a new superbug that defies treatment and could spread rapidly around the world, a leading Canadian medical microbiologist says.

Both Canadians, one in Alberta and one in B.C. infected by the antibiotic-resistant NDM-1 have recovered but, “we don’t know if the infection will come back,” Dr. Johann Pitout of the University of Calgary told the Star on Wednesday.

What scientists do know about this new discovery, reported Wednesday inhttp://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70143-2/abstractThe LancetEND, is that it starts with a new gene, NDM-1, that secretes an enzyme that blocks almost all antibiotics from fighting certain bacteria, including the common E coli.

The superbugs “are potentially a major global health problem,” said study http://medicine.cf.ac.uk/en/person/tim-walsh/lead author Dr. Timothy Walsh of the University of Cardiff, WalesEND. “It is likely NDM-1 will spread worldwide.”

Indeed, since NDM-1 was first detected in 2008 in a handful of British and Indian cases, it’s jumped to 180 in India, Pakistan, Bangladesh and the U.K. in the study. That doesn’t include the Canadian orhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5924a5.htmthreeU.S. cases reported in late June by the U.S. Centers for Disease ControlEND.

Superbug NDM-1a

Their ages ranged from 4 to 66, and the reasons for hospitalization included bone-marrow transplants, dialysis, heart disease, pregnancy, traffic accidents, burns and cosmetic surgery.

All of the infections, including the Canadians and Americans, started with hospitalization in India or Pakistan, sometimes for cheaper or quicker elective surgery than was available in the West.

Pitout revealed the Alberta case.

Sylwia Gomes, spokesperson for the Public Health Agency of Canada, knew of the B.C. case reported in February “in a patient transferred from a hospital in India.”

“We’ve been aware of this situation for some time, and we’ve been closely monitoring it both in Canada and globally for the past year,” Dr. Howard Njoo, director general for the Centre for Communicable Diseases and Infection Control, told The Canadian Press.

“And as a result, with the patient being isolated and so on, there was no further spread of infection to anyone else in the hospital,” he said.

“The take-home message for the Canadian public is, if you travel to the subcontinent and you get admitted to hospital for whatever reason, medical or cosmetic surgery, and you come back and get sick, you should tell somebody you’ve been in hospital in India or Pakistan,” Pitout said.

Pitout, in a Commentary in The Lancet, goes one step further, suggesting screening and testing of anyone returning to Canada after medical procedures in India or Pakistan.

“If this emerging public health threat is ignored, sooner or later the medical community could be confronted with” untreatable antibody-resistant bacteria that trigger big increases in health-care costs, Pitout wrote.

The Lancet report is based on small numbers, said Yasmeen Sayeed of Surgical Tourism Canada, an agency that helps Canadians get connected with hospitals in India.

india

“We send about 40 patients every month to India and I haven’t heard of any problems,” she said, adding that food-borne infections happen in that country, especially in the summer.

“We tell our patients to be very careful. . . only drink bottled water and even advice them to use it (bottled water) for brushing teeth.”

She added that their patients stay at high-end hotels.

Surgical Tourism Canada has its head office in Vancouver, but Sayeed said her clients are from across the country and go to India mostly for orthopedic procedures and weight-loss surgeries.

But lately, dozens of MS patients have travelled for the controversial Liberation treatment that is not available in Canada. The organization has a tie-up with two hospitals in India: Apollo and Fortis group. Patients go to the Indian cities of Chennai, Bangalore and New Delhi.

Chennai, a city in southern India, has been mentioned in the Lancet report. Sayeed said she knew that a couple of her clients got food-poisoning while in Bangalore for medical procedures but not in Chennai. However, she has asked doctors at these two hospital chains about precautions they are taking against the superbug.

“I’ve asked them if our patients should be concerned and what are they doing about it,” she said. “Of course, we take this very seriously. We don’t want our patients to have any problems.”

NDM-1, the study found, has alarming potential to spread. The gene was found on DNA structures that can flip from one bacteria to another. Even worse, the bacteria are gram-negative, which are already highly resistant to antibiotics and for which no new drugs are being created, said Pitout.

The gene “is widespread,” said Pitout, “but we don’t know how common it is. We don’t know what the risk is of a patient getting it or how many E. coli in India have it.”

It has been seen largely in E. coli bacteria, the most common cause of urinary tract infections, and produces an infection that is uncomfortable but not deadly.

 

“It’s unlikely to kill anybody,” he said.

Walsh and colleagues first discovered the gene in 2009 in bacteria taken from a Swedish patient who had been admitted to hospital in India. British health authorities issued a health alert in July 2009, about the rising toll of Britons infected by the superbug after “medical tourism.”

“The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed,” the authors wrote.

“It is disturbing, in context, to read calls in the popular press for U.K. patients to opt for corrective surgery in India with the aim of saving the National Health Service money,” the study concluded. “Such a proposal might ultimately cost the NHS substantially more than the short-term saving. The potential for wider international spread (is) clear and frightening.”

‘Health tourists’ flocking to south Asia have carried a new class of antibiotic-resistant superbugs to Britain, researchers reported on Wednesday, warning that the bacteria could spread worldwide.

Many hospital infections that were already difficult to treat have become even more impervious to drugs due to a recently discovered gene that can jump across different species of bacteria.

This so-called NDM-1 gene was first identified last year by Cardiff University’s Timothy Walsh in two types of bacteria – Klebsiella pneumoniae and Escherichia coli – in a Swedish patient admitted to hospital in India.

Worryingly, the new NDM-1 bacteria are resistant even to carbapenems, a group of antibiotics often reserved as a last resort for emergency treatment for multi-drug resistant bugs.

Researchers said the bugs had been brought into Britain by patients who travelled to India or Pakistan for cosmetic surgery.

‘If these infections were allowed to continue without appropriate treatment, then certainly one would expect to see some sort of mortality,’ Walsh, a microbiology professor, told BBC radio.

‘It’s going to be very difficult to treat the infections once the patients present with these types of bacteria. You won’t get well.’

In the new study, led by Walsh and Madras University’s Karthikeyan Kumarasamy, researchers set out to determine how common the NDM-1 producing bacteria were in South Asia and Britain, where several cases had turned up.

Checking hospital patients with suspect symptoms, they found 44 cases – 1.5 per cent of those screened – in Chennai, and 26 (eight per cent of those screened) in Haryana, both in India.

They likewise found the superbug in Bangladesh and Pakistan, as well as 37 cases in Britain, some in patients who had recently returned from having cosmetic surgery in India or Pakistan.

‘India also provides cosmetic surgery for other Europeans and Americans, and it is likely that NDM-1 will spread worldwide,’ said the study, published in British medical journal The Lancet.

NDM-1 was mostly found in E. coli, a common source of community-acquired urinary tract infections, and K. pneumoniae, and was impervious to all antibiotics except two, tigecycline and colistin.

In some cases, even these drugs did not beat back the infection.

‘We’ve actually almost run out of antibiotics. We only have two left and one isn’t particularly good,’ Walsh told the BBC.

Crucially, the NDM-1 gene was found on DNA structures, called plasmids, that can be easily copied and transferred between bacteria, giving the bug ‘an alarming potential to spread and diversify’, the authors said.

‘Unprecedented air travel and migration allow bacterial plasmids and clones to be transported rapidly between countries and continents,’ they said, adding that most could remain undetected.

The emergence of these new drug-resistant strains could become a serious global public health problem as the major threat shifts toward a broad class of bacteria – including those armed with the NDM-1 gene – known as ‘Gram-negative’, the researchers warn.

‘There are few new anti-Gram-negative antibiotics in development, and none that are effective against NDM-1,’ the study said.

NDM-1 stands for New Delhi metallo-beta-lactamase-1.

‘We believe it’s present within the community within India – not just within the hospitals,’ Walsh said.

The professor said that looking ahead to what might be available to treat NDM-1, ‘there are no new antibiotics that are going to be available in 10 years’ time’.

He added: ‘We desperately need – in the 21st century it sounds ridiculous that we don’t have – a globally-funded surveillance system.

‘Secondly, there is a desperate need for new and novel antibiotics targeted towards these types of bacteria.’

A new superbug that is resistant to even the most powerful antibiotics has entered UK hospitals, experts warn.

They say bacteria which make an enzyme called NDM-1 travelled back with NHS patients who had gone abroad to countries like India and Pakistan for treatments such as cosmetic surgery.

Although there have only been about 50 cases identified in the UK so far, scientists fear it will go global.

Tight surveillance and new drugs are needed says Lancet Infectious Diseases.

NDM-1 can exist inside different bacteria, like E.coli, and it makes them resistant to one of the most powerful groups of antibiotics – carbapenems.

These are generally reserved for use in emergencies and to combat hard-to-treat infections caused by other multi-resistant bacteria.

And experts fear NDM-1 could now jump to other strains of bacteria that are already resistant to many other antibiotics.


Ultimately, this could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.

At least one of the NDM-1 infections the researchers analysed was resistant to all known antibiotics.

Similar infections have been seen in the US, Canada, Australia and the Netherlands and international researchers say that NDM-1 could become a major global health problem.

Infections have already been passed from patient to patient in UK hospitals.

The way to stop NDM-1, say researchers, is to rapidly identify and isolate any hospital patients who are infected.

Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.

And currently, most of the bacteria carrying NDM-1 have been treatable using a combination of different antibiotics.

But the potential of NDM-1 to become endemic worldwide is “clear and frightening”, say the researchers in their Lancet paper.

Don’t panic, but be warned, another Super Bug is lurking. Move over H1N1, out of the way SARS, NDM-1 is taking the driving seat. Recent Health Reports have identified this new “bug” as one of the more dangerous enzymes out there. This antibiotic resistant superbug is starting to spread though out numerous countries including the UK, Australia, Canada, the Netherlands and the USA.

This devious bug will gain access to the victims system by hiding in something else such as E.Coli. Think “Trojan Horse” deception. Once it gains access by disguise, it is too late. It will spread this way from patient to patient with no guaranteed way to kill it. Health Officials fear it is a matter of time before this becomes a huge health epidemic.

The greatest amount of cases involve those that have recently traveled abroad to India. Especially those who have sought alternative health treatments. One study out of Cardiff University in England reported 17 out of 37 cases had visited India or Pakistan prior to becoming ill, with the majority seeking cheaper cosmetic surgery as the primary reason of the trip.

Doctors in India aren’t surprised that the Super Bug probably originated there. Drug control there is poor and common antibiotics have become ineffective in India. Some reasons may be because people can buy powerful antibiotics over the counter leading to over use. They also take small doses and discontinue treatment in order to save money. There are no current antibiotics, nor any in development, that can kill NDM-1 on their own.

Researchers have indicated that the way to stop NDM-1 before it runs out of control is to rapidly identify and isolate any hospital patients who are infected. Normal infection control measures, such as disinfecting hospital equipment, hospital staff and visitors washing their hands with antibacterial soap, and patient isolation can stop the spread. A recently documented case had one hospital scrambling. Fiona Coogan, a health director of several London hospitals stated hospital staff took several precautionary measures. Staff did indeed isolate the patient. They had to wear disposable gowns and gloves when dealing with the patient as well. Only a single member on shift was allowed access. Since the recent discharge, the rooms have been fumigated to ensure no trace of the superbug remained.

The HPA issued a National Resistance Alert in 2009 after they noted an increasing number of cases, some of them fatal, emerging in the UK. The Centers for Disease Control in the United States issued a similar warning in June 2010 after three cases of infections arising from NDM-1 were detected between January and June.

The UK is battling a superbug gene which makes nearly any bacteria a superbug, resistant to antibiotics. People who had undergone recent surgery in India or Pakistan brought the resilient gene back home with them.

File:Bacteria-.svgAccording to MSN.com, the superbug gene, NDM-1, amazingly alters bacteria to make them immune to most drugs. NDM-1 has spread from India to the UK and also to “Australia, Canada, the U.S., the Netherlands and Sweden.” The superbug is now on the verge of becoming a worldwide concern.

A combination of new drugs are now sought to kill the superbug in the reported 50 UK cases. Doctors say the only way to end NDM-1 from spreading is to quarantined those showing signs of infection immediately.

Speaking about the potential for NDM-1 to go global, UK’s Health Protection Agency (HPA) researcher Dr David Livermore said, “The fear would be that [the superbug gene] gets into a strain of bacteria that is very good at being transmitted between patients.

Dr. Livermore’s fears are well founded and this scenario is similar to many frightening science fiction medical horror movies… But it’s real and it could wipe out a large portion of the Earth’s population if left unattended. Hopefully all the cases have been found out and all those infected be placed in quarantine.

India raged by UK scientists for false NDM-1 superbug propaganda

Posted by Rupali Gupta on August 13, 2010, filed in: Diseases, Health News

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News about super bug consisting of New Delhi metallo beta lactamase (NDM-1) enzyme is still hot on the plate and claimed that bacteria was spread from hospitals in India and Pakistan.  This strain of bacteria is touted as resistant to almost every antibiotic and hence poses threat to the human life.  India was quick to respond and rejected claim of British scientist that NDM-1 enzyme was originated from India. Indian health ministry said it was unfair to link the bug to India and officials described it as “malicious propaganda”.

Indian health officials responded in a press release by saying that the “plasmid”, associated with drug resistance to antibiotics, is present “in the environment, may be in the intestines of humans and animals universally.”

Bad publicity to Indian Medical Tourism Industry
Medical Tourism has been gaining momentum from past few years and is projected to growth at a rate of double digits for next decade or so.  As a part of this Medical Tourism, patients from all over the world are tapping into medical facilities in countries like India due to significant lower cost.  Many officials responded to this BBC report as sensational, unfair and wrong propaganda.  Some of the specific comments include:

  • We strongly refute the naming of this enzyme as New Delhi metallo beta lactamase
  • We also refute that hospitals in India are not safe for treatment, including medical tourism
  • When India is emerging as a medical tourism destination, this type of news is unfortunate and may be a sinister design of multi-national companies, said MP SS Ahluwalia of the opposition Bharatiya Janata Party.
  • Congress party’s Jayanthi Natarajan said the report of the superbug was a “wrong propaganda against the country”.

It may be difficult to pinpoint the origin of NDM-1 enzyme as indicated by an Indian official “a person could become infected with the drug-resistant bacteria anywhere in the world”.  I think, it will be difficult to dig out roots of origin of NDM-1 enzyme.  One way of approaching it would be to look at two – three months travel history of the affected patients and alert authorities of those places of risk of NDM-1 infection.  Proper action is needed to eliminate this infection as its spread can be much more deadly than recent swine flu pandemic.

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