Wednesday, September 15, 2010

Antibiotic-Resistant Superbug With NDM-1 Enzyme

NDM-1, a "superbug" that's resistant to antibiotics, has shown up in the United States. It's been a problem in India for some time - and may have originated there. Or, not.

Anyway, the "ND" in NDM-1 stands for New Delhi, and India's being credited - or blamed - for being where this nasty line of diseases showed up.

The states where NDM-1 has been diagnosed are:
  • California
  • Massachusetts
  • Illinois

"UPDATE: New Drug-Resistant Superbugs Found in 3 States"
FOXNews (September 14, 2010)

"An infectious-disease nightmare is unfolding: Bacteria that have been made resistant to nearly all antibiotics by an alarming new gene have sickened people in three states and are 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, creating dangerous 'superbugs.'..."

So far, so good. The article gives a pretty good account of what's happened recently with this new kind of bacterium. Bacteria, actually: there are three varieties, each of which got the new-and-improved gene for NDM-1 a different way.

And a tip of the Lemming's hat, for giving some useful information:

"...What can people do?

"Don't add to the drug resistance problem, experts say. Don't pressure your doctors for antibiotics if they say they aren't needed, use the ones you are given properly, and try to avoid infections by washing your hands.

"The gene is carried by bacteria that can spread hand-to-mouth, which makes good hygiene very important...."

'Natives' and 'Citizens:' Maybe It's Time to Think 'People'

The hat goes back on for what came after those two paragraphs:

"...It's also why health officials are so concerned about where the threat is coming from, said Dr. Patrice Nordmann, a microbiology professor at South-Paris Medical School. India is an overpopulated country that overuses antibiotics and has widespread diarrheal disease and many people without clean water...."

"Overuses antibiotics?" Maybe. But the Lemming's run into enough articles bewailing the habit of Americans to prescribe - or insist on - antibiotics for annoyances like the common cold. Which is caused by a virus, by the way, and unaffected by bacteria-killing antibiotics. India may over-use antibiotics, too: but the country doesn't have a monopoly on that regrettable habit.

"Overpopulated?" These days, 'everybody knows' that places like India and Nigeria are "overpopulated." Unlike places such as New York City and Los Angeles, which just have a lot of people. That's another topic: discussed in some of the Related and Vaguely-related posts linked to at the end of this one. We've been "overpopulated" ever since some reckless maniac developed agriculture - and that's definitely another topic. (Drifting at the Edge of Time and Space (October 2, 2009))

Bullets Won't Stop Them!

The Lemming thinks a key word in descriptions of bacteria with the NDM-1 enzyme is antibiotic-resistant. Not antibiotic-proof, antibiotic-resistant. As the article points out:

"...Doctors have tried treating some of these cases with combinations of antibiotics, hoping that will be more effective than individual ones are. Some have resorted to using polymyxins — antibiotics used in the 1950s and '60s that were unpopular because they can harm the kidneys...."

All other things being equal, I'd just as soon not go back to using the almost-worse-than-the-disease antibiotics that generally killed the disease before killing the patient. But too many folks in too many parts of the world - America included - have been too eager to use (and misuse) antibiotics.

The Lemming really doesn't think this is an 'and we're all gonna die!' situation. Antibiotic-resistant bacteria are more of a problem now than they were when I was younger: but we've licked polio and smallpox - I think we will endure this, too.

And, maybe learn not to be stupid about using medicine. Maybe.

Here's another article on the travels of Superbug:
"US citizens carried Superbug from India"
Hindustan Times (September 14, 2010)

"Three people returned to the US from India earlier this year infected with the newly described 'superbugs' that are highly resistant to antibiotics, according to media reports. All three confirmed cases - one each in California, Illinois and Massachusetts - involved people who got medical care in India, the Chicago Tribune said citing the US Centres for Disease Control and Prevention (CDC).

"The Illinois patient recovered, and there is no evidence the infection was transmitted to other people, the daily said citing Illinois Department of Public Health spokeswoman Melaney Arnold who released no other details about the case.

"Another person was treated at Massachusetts General Hospital and isolated, a measure that prevented the germ from spreading, said David Hooper, chief of the hospital's infection control unit, the Boston Herald said.

"The Massachusetts patient too survived. The daily said the superbug seems to have been contained...."

Good News

It's good news that the folks who were diagnosed in this country (the Lemming lives in America, the United States of) survived. And that the antibiotic-resistant bugs seem to have been contained. In the United States. So far.

As for why someone who lives in America would want to get medical care in India? Some of us are from India, and I can imagine someone wanting to go back to the old country for treatment: for personal or family reasons. And, as seems to be the case for at least one of the three folks mentioned, they were traveling in India when something happened that require attention - and wouldn't wait.
"Taiwan puts hospitals on alert against NDM1 superbug"
Times of India (September 10, 2010)

"With the antibiotic resistant superbug NDM1, that scientists claimed originated in India springing up in almost 14 countries, Taiwan on Thursday decided to declare it a category-four communicable disease.

"This means that hospitals and clinics will have to immediately report any suspected cases.

"The bug, which is named from an enzyme called New Delhi metallo-beta-lactamase-1, has been found in patients from United Kingdom, US, Canada, Australia, Netherlands and Japan, who had recently returned from India after medical treatment.

"According to Taiwan's Centre for Disease Control, NDM-1 has the potential to become a serious public health problem as the superbug is extremely virulent and resistant to almost all antibiotics, even the most powerful ones...."

Not-So-Good News

It's not good news that bacteria with the new gene for making NDM-1 enzyme got into a dozen or more countries. Looks like the genie is definitely out of the bottle for this antibiotic-resistant set of microbes.

On the other hand, as I wrote before, the key word is resistant. The new gene doesn't convey invulnerability on its host - the bugs are just harder to kill.
All of this isn't exactly "new" news. Check the date on this CDC publication:
"Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase --- United States, 2010"
Morbidity and Mortality Weekly Report (MMWR), Centers for Disease Control and Prevention (CDC) (June 25, 2010)

"During January--June 2010, three Enterobacteriaceae isolates carrying a newly described resistance mechanism, the New Delhi metallo-beta-lactamase (NDM-1) (1), were identified from three U.S. states at the CDC antimicrobial susceptibility laboratory. This is the first report of NDM-1 in the United States, and the first report of metallo-beta-lactamase carriage among Enterobacteriaceae in the United States. These isolates, which include an Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, carry blaNDM-1, which confers resistance to all beta-lactam agents except aztreonam (a monobactam antimicrobial) (1); all three isolates were aztreonam resistant, presumably by a different mechanism. In the United Kingdom, where these organisms are increasingly common, carriage of Enterobacteriaceae containing blaNDM-1 has been closely linked to receipt of medical care in India and Pakistan (2). All three U.S. isolates were from patients who received recent medical care in India...."

  1. Yong D, Toleman MA, Giske CG, et al. Characterization of a new metallo-β-lactamase gene, blaNDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046--54.
  2. Health Protection Agency. Multi-resistant hospital bacteria linked to India and Pakistan. Health Protection Report 2009;3(26):3--4. Available at Accessed June 18, 2010.
  3. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twentieth informational supplement. Wayne, PA: Clinical and Laboratory Standards Institute; 2010.
  4. Deshpande P, Rodrigues C, Shetty A, Kapadia F, Hedge A, Soman R. New Delhi metallo-β lactamase (NDM-1) in Enterobacteriaceae: treatment options with carbapenems compromised. J Acad Physicians India 2010;58:147--9.
  5. CDC. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR 2009;58:256--60.....
The CDC also has a sort of FAQ on antibiotic-resistant bacteria:

"National Antimicrobial Resistance Monitoring System (NARMS) Frequently Asked Questions (FAQ) About Antibiotic Resistance - Why are bacteria becoming resistant to antibiotics?"
NARMS, CDC (June 1, 2005)

It's about as readable as you'd expect from the title: but I think it's worth wading through the page.

Look! There in the News! It's a Germ! It's a Plague! No, It's - SUPERBUG!

Yes, Superbug: strange being from another continent, come to America with powers and abilities far beyond those of ordinary bugs. Superbug! Resistant to most antibiotics; able to make people sick.

But not, I think, something that's going to bring about 'an end to civilization as we know it.'

Good grief: We survived smallpox, disco, and the 2009 swine flu. I think we can learn to cope with a bug that's resistant to standard-issue antibiotics.

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