Doctors Warn New Superbug Spreading from South Asia and Now Found in UK Hospitals

New 'Superbug' Found in UK Hospitals

August 11, 2010

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

They say bacteria that make an enzyme called NDM-1 have travelled back with NHS patients who went 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 Lancet infectious diseases paper.

The research was carried out by experts at Cardiff University, the Health Protection Agency and international colleagues.

Dr David Livermore, one of the researchers and who works for the UK's Health Protection Agency (HPA), said:

"There have been a number of small clusters within the UK, but far and away the greater number of cases appear to be associated with travel and hospital treatment in the Indian subcontinent.

"This type of resistance has become quite widespread there.

"The fear would be that it gets into a strain of bacteria that is very good at being transmitted between patients."

He said the threat was a serious global public health problem as there are few suitable new antibiotics in development and none that are effective against NDM-1.

The Department of Health has already put out an alert on the issue, he said.

"We issue these alerts very sparingly when we see new and disturbing resistance."

Travel history

The National Resistance Alert came in 2009 after the HPA noted an increasing number of cases - some fatal - emerging in the UK.

The Lancet study looked back at some of the NDM-1 cases referred to the HPA up to 2009 from hospitals scattered across the UK.

At least 17 of the 37 patients they studied had a history of travelling to India or Pakistan within the past year, and 14 of them had been admitted to a hospital in these countries - many for cosmetic surgery.

For some of the patients the infection was mild, while others were seriously ill, and some with blood poisoning.

A Department of Health spokeswoman said:

"We are working with the HPA on this issue.

"Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.

"So far there has only been a small number of cases in UK hospital patients. The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues."

The Welsh Assembly Government said it would be "fully considering" the report.

"The NHS in Wales is used to dealing with multi-resistant bacteria using standard microbiological approaches, and would deal with any new bacteria in a similar way," said a spokesperson.

Analysis

The Indian health ministry and the medical fraternity are yet to see the Lancet report but doctors in India say they are not surprised by the discovery of the new superbug.

"There is little drug control in India and an irrational use of antibiotics," Delhi-based Dr Arti Vashisth told the BBC.

Doctors say common antibiotics have become ineffective in India partly because people can buy them over the counter and indulge in self-medication. They also take small doses and discontinue treatment.

Gastroenterologist Vishnu Chandra Agarwal says in the past year he has come across many patients with E.coli infections who have not responded to regular antibiotics.

"In about a dozen cases, I have used a chemical - furadantin - to treat my patients. And it has worked. It makes them horribly nauseous, but it works," he says.

British Doctors Warn New Superbug Could Spread

August 11, 2010

AP – British scientists have found a superbug that is resistant to most antibiotics and are warning that it is widespread in India and could soon appear worldwide.

The superbug has so far been identified in 37 people who returned to the U.K. after undergoing surgery in India or Pakistan.

In an article published online Wednesday in the journal Lancet Infectious Diseases, doctors reported finding a new gene, called NDM-1. The gene alters bacteria, allowing them to become resistant to nearly all known antibiotics. It has been seen largely in E. coli bacteria, the most common cause of urinary tract infections, and on DNA structures that can be easily copied and passed onto other types of bacteria.

The researchers said the superbug appeared to be already circulating widely in India, where the health system is much less likely to identify its presence or have adequate antibiotics to treat patients.

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

Aside from the U.K., the resistant gene has also been detected in Australia, Canada, the Netherlands, the U.S. and Sweden. The researchers said that since many Americans and Europeans travel to India and Pakistan for elective procedures like cosmetic surgery, it was likely the superbug would spread worldwide.

"The spread of these multi-resistant bacteria merits very close monitoring," wrote Johann Pitout of the division of microbiology at the University of Calgary, Canada, in an accompanying commentary.

Pitout called for international surveillance of the bacteria, particularly in countries that actively promote medical tourism.

"The consequences will be serious if family doctors have to treat infections caused by these multi-resistant bacteria on a daily basis."

New Superbugs Spreading from South Asia: Study

August 11, 2010

AFP - Plastic surgery patients have carried a new class of superbugs resistant to almost all antibiotics from South Asia to Britain and they could spread worldwide, researchers reported Wednesday.

Many hospital infections that were already difficult to treat have become even more impervious to drugs thanks 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.

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 percent of those screened -- in Chennai, and 26 (eight percent) in Haryana, both in India.

They likewise found the superbug in Bangladesh and Pakistan, as well 37 cases in Britain, where several patients had recently travelled to India or Pakistan for cosmetic surgery.

"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 the 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.

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," mostly undetected, they said.

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.

Johann Pitout from the University of Calgary in Canada said patients who have medical procedures in India should be screened for multi-resistant bacteria before they receive care in their home country.