Researchers at an American Society for Microbiology conference in Boston this week are racheting up the anxiety over the emergence of the NDM-1 super bug. This from AP via the the Globe:
A new gene that can turn many types of bacteria into superbugs resistant to nearly all antibiotics has sickened people in three states and is popping up all over the world, health officials reported Monday.
The U.S. cases and two others in Canada all involve people who had recently received medical care in India, where the problem is widespread. A British medical journal revealed the risk last month in an article describing dozens of cases in Britain in people who had gone to India for medical procedures.
How many deaths the gene may have caused is unknown; there is no central tracking of such cases. So far, the gene has mostly been found in bacteria that cause gut or urinary infections.
Scientists have long feared this — a very adaptable gene that hitches onto many types of common germs and confers broad drug resistance.
Here’s a link to the webcast of this morning’s conference presentation.
This is not super new news, even though the meeting is generating some attention. From the NY Times in August
Experts in antibiotic resistance called the gene mutation, named NDM-1, “worrying” and “ominous,” and they said they feared it would spread globally.
But they also put it in perspective: there are numerous strains of antibiotic-resistant germs, and although they have killed many patients in hospitals and nursing homes, none have yet lived up to the “superbug” and “flesh-eating bacteria” hyperbole that greets the discovery of each new one.
“They’re all bad,” said Dr. Martin J. Blaser, chairman of medicine at New York University Langone Medical Center. “Is NDM-1 more worrisome than MRSA? It’s too early to judge.”
More here from Medscape.
The New Delhi metallo-beta-lactamase 1 (NDM-1) is a novel mechanism that has conferred carbapenem resistance on gram-negative Enterobacteriaceae.
NDM-1 is of particular concern because it appears to have multiple ways of moving and so enabling the spread of resistant pathogens;
It was first identified in India, Pakistan, and the United Kingdom and recently 3 isolated cases have been found in the United States (in California, Illinois, and Massachusetts).
Carbapenem resistance in Enterobacteriaceae is not unique to NDM-1. It is a major problem in Klebsiella pneumoniae carbapenemases (KPC), which is endemic in some areas of the United States.
In the United States, NDM-1 would most likely first be identified in urinary tract infections, mainly among people who have exposure in healthcare settings.
The 3 NDM-1 clinical isolates currently identified in the United States were not a result of medical tourism. However, patients who travel overseas for medical care should obtain good information on levels of quality either from the medical centers where they’re going or from the people who are sending them there. A good source of information on medical tourism can be found in the CDC yellow book.
Clinicians who identify patients with carbapenem-resistant Enterobacteriaceae, especially in a nonendemic area, should inquire specifically about whether that patient has been abroad to India or Pakistan and whether he or she received medical care there. Then, the clinician should forward on to their state labs and CDC any isolates associated with travel and medical care in those countries.
- CDC report from June.
- In August, The Lancet looked at prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK.