SUPER BUG NDM-1AMOL E. GAIKWAD

Index

What is Super bug

Antibiotic resistance

NDM-1 gene

NDM-1 symptoms

Why every one concerned?

Controversy

Blame on India

Comment from Health Ministry

CII estimates

Treatment options?

CDC infection control guidance

References

What is Superbug

Gene can be transferred between bacteria in horizontal fashion by conjugation, transduction or transformation; thus a gene for antibiotic resistance which had evolved via natural selection may be shared.

Many antibiotic resistance gene resides on plasmids, facilitating their transfer.

If a bacterium carries several antibiotic resistance genes it is called multiresistant or informally a SUPERBUG or super bacteria

Origin of Antibiotic

Résistance The widespread use

of antibiotics both inside and outside of medicine is playing a significant role in the emergence of resistant bacteria. (Super bug)

In India antibiotics that are sold most often without prescription include Tetracycline, Amoxycillin, Ofloxacin and Ciprofloxacin

NDM-1 Gene

Is a type of Carbapenem resistance gene,

designated as blaNDM-1. or also designated as

NDM-1 gene.

It is coded with ND Mettalo-beta-lactamase

enzyme (here ND stands for New Delhi)

NDM-1 symptoms

NDM-1 symptoms are reported to be associated with the bacteria it attaches to.

The currently known bacteria's hosting this gene are E.Coli and Klebsiellapneumoniae.

The majority of the patients treated to date who are positive for NDM-1 were those with G.I. tract infections, bacteraemia, or pneumonia

May cause multi-organ failure leading to death.

NDM-1 genes can live inside different bacteria

and is resistant to currently available

antibiotics.

NDM-1 is the gene responsible for the newest

superbug.

New Delhi metallo-beta-

lactamase Why everyone

concerned ? NDM-1 gene is found in several countries

The antibiotics shown to work against NDM-1are older generation (Colistin & Tigecycline) that can have toxic side effect on patients renal system.

There are currently no new drugs in the research pipelines that aim to stop NDM-1.

Infectious Disease society of America has launched a “bad bugs need drugs” campaign to promote the development of new antibiotics by 2020.

The closest new antibiotic in development is still at least 18 months away from the market.

Naming the gene as New Delhi

creates Controversy

The gene was named after New Delhi, the capital

city of India, as it was first described by Yong et al.

in 2008 in a Swedish national who fell ill with an

antibiotic-resistant bacterial infection that he

acquired in India .

The infection was unsuccessfully treated in a New

Delhi hospital and after the patient's repatriation to

Sweden, a Carbapenem-resistant Klebsiella

pneumoniae strain, bearing the novel gene was

identified.

The authors concluded that the new resistance

mechanism clearly arose in India.

Blame on India is it justified ?

The US cases occurred this year in people

from California, Massachusetts and Illinois

All 3 gave the history of travel & hospitalization

to India prior to the illness.

India lacks policies on antibiotics and infection

control.

Also there no registered data available

regarding the hospital acquired infections.

A joint study led by Chennai based Karthikeyan

Kumarasamy, at university of Madras and UK

based Timothy Walsh from department of

immunity, infection and Biochemistry, department

of Medicine, Cardiff University researchers sought

to examine whether NDM-1 producing bacteria

was prevalent in south Asia and Britan

They found the superbug in 44 patients in

Channai, and 26 in Haryana, besides 37 in the UK

and 73 in other places across India, Pakistan and

Bangaladesh.

Comments from Health Ministry

It is unfortunate that the new

bug, which is an environmental

thing, has been attached to a

particular country which is India in

this case.

Various comments

ICMR:- said it is an attempt to hurt medical

tourism in the country that is taking away huge

customs from hospitals in the west.

“Such infections can flow in, from any part of

the world. It is unfair to say it originated from

India.” –ICMR director Dr. V.M. Katoch

Confederation of Indian Industry

(CII) estimates

1.1 million foreigners travel to India each year for cheaper treatments and surgeries.

A heart bypass surgery costs $6,500 (Rs.3,03,550) in a corporate hospital in India, as compared to $30,000 (Rs.14,01,000) to $50,000 (Rs.23,35,000) in the U.S.

We offer better surgical outcomes at one-fifth the cost- Dr. Ashok Seth (Chairman Escort Heart Institute and Research centre)

Most hospitals in India have National & Internatonal accreditation, who send auditors to track quality- including infections – four times a year.

Do we have options to treat ?

Treatment

presents major

challenges. Most

isolates with

NDM-1 enzyme

are resistant to all

standard

intravenous

antibiotics for

treatment of

severe infections

CDC infection control guidance

CDC infection control guidance for carbapenem-resistant Enterobacteriaceae also is appropriate for NDM-1--producing isolates .

This includes recognizing carbapenem-resistant Enterobacteriaceae when cultured from clinical specimens, placing patients colonized or infected with these isolates in contact precautions

and in some circumstances, conducting point prevalence surveys or active-surveillance testing among other high-risk patients.

Surveillance helps effective

care to prevent spread

The goal of active surveillance is to identify

undetected carriers of carbapenem-resistant or

carbapenemase-producing Klebseilla spp. and E.

coli.

Identification of other cases among patients with

epidemiologic links to persons with confirmed

infection suggests patient-to-patient transmission ;

in such instances, infection prevention measures

should be vigorously reinforced, and surveillance

cultures repeated periodically (e.g., weekly) until

no new cases are identified

Phenotypic detection with Hodge

test a Minimal requirement

Carbapenem resistance and carbapenemase production conferred by blaNDM-1 is detected reliably with phenotypic testing methods currently recommended by the Clinical and Laboratory Standards Institute , including disk diffusion testing and the modified Hodge test

The spread of NDM-1 can be

contained with ..

The spread of

NDM-1 within

health-care

facilities can be

curbed through

strict infection-

control measures,

including patient

isolation and hand

washing.

References

www.thelancet.com/infection published online August 11,2010 DOI:10.1016/S1473-3099(10) 470143-2

www.hindustantimes.com/storypage/585442, August 12,2010

www.ibnlive.in.com

www.timesofindia.indiatimes.com/articleshow/6295662

www.stltoday.com/lifestyles/health-med-fit/fitness/article

www.en.wikipedia.org/wiki/super_bug_(bacteria)

Loss AnglisTimes,collectio,bacteria,september21,2010

The Sunday Express, August 29,2010;p9

Thank You