August 12, 2010
By Vinny Ciancio
Don’t panic, but be warned, another Super Bug is lurking. Move over H1N1, out of the way SARS, NDM-1 is taking the driving seat. Recent Health Reports have identified this new “bug” as one of 
the more dangerous enzymes out there. This antibiotic resistant superbug is starting to spread though out numerous countries including the UK, Australia, Canada, the Netherlands and the USA.
This devious bug will gain access to the victims system by hiding in something else such as E.Coli. Think “Trojan Horse” deception. Once it gains access by disguise, it is too late. It will spread this way from patient to patient with no guaranteed way to kill it. Health Officials fear it is a matter of time before this becomes a huge health epidemic.
The greatest amount of cases involve those that have recently traveled abroad to India. Especially those who have sought alternative health treatments. One study out of Cardiff University in England reported 17 out of 37 cases had visited India or Pakistan prior to becoming ill, with the majority seeking cheaper cosmetic surgery as the primary reason of the trip.
Doctors in India aren’t surprised that the Super Bug probably originated there. Drug control there is poor and common antibiotics have become ineffective in India. Some reasons may be because people can buy powerful antibiotics over the counter leading to over use. They also take small doses and discontinue treatment in order to save money. There are no current antibiotics, nor any in development, that can kill NDM-1 on their own.
Researchers have
indicated that the way to stop NDM-1 before it runs out of control is to rapidly identify and isolate any hospital patients who are infected. Normal infection control measures, such as disinfecting hospital equipment, hospital staff and visitors washing their hands with antibacterial soap, and patient isolation can stop the spread. A recently documented case had one hospital scrambling. Fiona Coogan, a health director of several London hospitals stated hospital staff took several precautionary measures. Staff did indeed isolate the patient. They had to wear disposable gowns and gloves when dealing with the patient as well. Only a single member on shift was allowed access. Since the recent discharge, the rooms have been fumigated to ensure no trace of the superbug remained.
The HPA issued a National Resistance Alert in 2009 after they noted an increasing number of cases, some of them fatal, emerging in the UK. The Centers for Disease Control in the United States issued a similar warning in June 2010 after three cases of infections arising from NDM-1 were detected between January and June.
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Drug resistance has evolved from time immemorial. It has crossed states, countries and continents with increasing travel (may it be for medical tourism or otherwise).
What makes a micro organism a ‘Superbug’ is the genetic makeup of the bacteria. These are usually coded in packets (Plasmids) in the bacteria and are transmitted just like human transmission of genetic mutations. The decoding of these plasmids give insight into the character of the bacteria (how long it will live, how many drugs it is resistant to, how fast they can be transmitted etc) and is similar to gene mapping in humans which tells the character of humans (colour, cancer carriers, genetic disorders, height, how long we will live, will he be diabetic etc).
Most superbugs can generally be detected in routine standard microbiology labs eg. MRSA (Methicillin resistant Staphylococcus aureus, ESBL (Extended spectrum beta lactamase) in E coli, Klebsiella and others, MBL (metallobetalactamase etc). Research studies can detect special characters (genetic makeup) in such bugs (e.g. in MRSA mecA, in ESBL- CTX-M, IMP, in MBL BlalMP, VIM, NDM-1 etc ) . Routine laboratories anywhere in the world cannot detect such special characters.
Superbugs are rare but when it occurs it should trigger ANY government, state, health care facility to the following aspects:
1. Resistance evolves in bacteria due to abuse of antibiotics. (so probably hospital or community physicians are abusing drugs). Abuse of antibiotics occurs usually in the subcontinent and south east asian countries.
2. Some codes are transmitted by drug feeds in poultry or the food we eat, how close we are with animals can manufacture and these bugs (Again antibiotic abuse).
3. Regular isolation of the same organism from the same location (hospital, country) can result in outbreaks or epidemics). Outbreaks of this organism can occur if the organism is transmitted quickly usually due to poor infection control practices in the hospitals.
4. The hospital should be aware and report such types of bugs both in the interest of the patient and community as a whole.
5. Its not where these isolates come from but how their transmission can be prevented that is important. Sometimes where it comes from is important as incase of Bioterrorism agents (Anthrax etc)
6. If increasing Superbugs are seen in a locality they should be tested in research laboratories to know the genetic makeup.
So don’t blame countries. Be scientific not political.
Learn to develop research facilities that can detect such infections.
Look into all Hospital systems and Microbiology laboratories to see if facilities are in place to identify and isolate superbugs.
Finally report these to the international community and the interest of patient care as a whole.
Dr Godwin Wilson, Clinical Microbiologist (Google me to Contact me)