SUPER BUG NDM-1

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 Rsistance

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. is coded with ND Mettalo-betalactamase enzyme (here ND stands for New Delhi)

It

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 Klebsiella pneumoniae. 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.
is the gene responsible for the newest superbug.

NDM-1

New Delhi metallo-beta-lactamase Why everyone concerned ?

NDM-1 gene is found in several countries The antibiotics shown to work against NDM1are 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.

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.

Naming the gene as New Delhi creates Controversy

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 each year for 1.1 million foreigners travel to India

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 carbapenemresistant 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/62 95662 www.stltoday.com/lifestyles/health-medfit/fitness/article www.en.wikipedia.org/wiki/super_bug_(bacteria) Loss Anglis Times,collectio,bacteria,september21,2010 The Sunday Express, August 29,2010;p9

Thank You