Some 77 cases of a multi-drug resistant “superbug” from India first reported in Britain in August have now been detected in 13 European countries, a scientist at the EU’s disease watchdog said on Wednesday.
Dominique Monnet of the European Center for Disease Prevention and Control (ECDC) said he was very worried by the emergence of NDM-1, or New Delhi metallo-beta-lactamase, and other bugs like it that are resistant to even the most powerful class of antibiotics, known as carbapenems.
“I know people are calling this NDM-1 a superbug, but for me NDM-1 and bacteria like it are more than superbugs. We’re talking about super superbugs,” Monnet said in a telephone interview from Stockholm, where the ECDC is based.
“For a long time … doctors in hospitals, especially in intensive care units, have relied on the carbapenems as the last line of antibiotic treatment. Now, for doctors facing a patient infected with a bacteria that is resistant to carbapenems, the options for treatment are limited.”
NDM-1 is a gene carried by bacteria that alters them and makes then resistant to almost all known antibiotics. It can manifest itself in many different ways and is often found in bacteria like Klebsiella pneumonia and E-coli, both of which can cause urinary tract infections and pneumonia.
superbug-ndm1
British researchers reported in August that cases of infection with NDM-1 bugs had been found in patients in South Asia and in Britain and said they feared it could spread around the world, in part because of medical tourism.
U.S. health officials said at the same time that three cases had been detected in the United States.
Monnet is due to publish a paper this week in online journal Eurosurveillance which shows how the bug is spreading in Europe.
In a separate briefing for reporters later on Wednesday, Monnet said a total of 77 NDM-1 cases had now been detected in 13 European countries, including Britain, France, Germany, Spain, Italy and others, between 2008 and 2010.
Around two-thirds of the cases were in Britain, he said, and data showed that seven of the infected patients had died.
“Most cases were associated with healthcare in or travel to the Indian subcontinent,” he said, a finding that confirmed what the British study also showed — that increasing international travel and medical tourism, where patients go abroad for treatment, are helping to spread superbugs around the world.
Monnet added that a small proportion of the NDM-1 cases were found in patients who had received healthcare in the Balkans.
Almost as soon as penicillin, the world’s first antibiotic, was introduced in the 1940s, bacteria began to develop resistance to its effects, prompting scientists and drug firms to work on developing many new generations of antibiotics.
Experts say their constant overuse and misuse have fueled the rise of drug-resistant superbugs such as Clostridium difficile, or methicillin-resistant Staphyloccus aureus (MRSA).
NDM-1
Now carbapenems — a class of the drugs traditionally reserved for last-line use and to treat infections caused by the likes of MRSA and C-difficile — are also becoming powerless in the face of ever more ingenious bacteria.
“Doctors have relied very much on the availability of new antibiotics,” Monnet said. “They have always had this kind of forward escape strategy of counting on the pharmaceutical industry to produce new antibiotics that will help counteract the emergence of resistance.”
“But what we have now is increasing multidrug resistant bacteria in the EU and at the same time a rather dry pipeline for new antibiotics. We are running out of antibiotics.”
A few large drugmakers, including Pfizer (PFE.N), Merck (MRK.N), AstraZeneca (AZN.L), GlaxoSmithKline (GSK.L) and Novartis (NOVN.VX), are hunting for new antibiotics but the scientific difficulty and expense of finding effective treatments is stacked against the limited sales potential of drugs that are typically reserved for the sickest patients.
Experts cite only two drugs that can stand up to carbapenem-resistant infections.
One is colistin, an older antibiotic which Monnet said has such toxic side effects that it would probably not be approved for a license under today’s drug regulation standards. The other is Pfizer’s antibiotic Tygacil, known generically as tigecycline, which Monnet said only works in some cases.
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A new strain of the superbug MRSA has been found in the Isle of Man, the Department of Health (DoH) has confirmed.
The DoH said it had recently detected a small number of cases of a bacterium called MRSA USA 300.
The strain mostly affects young, fit and healthy people, is transmitted in sports centres, gyms, and pools and can cause serious infection, the DoH said.
Like all strains, it is resistant to many antibiotics, it added.
Dr Katie Laird, senior lecturer in pharmaceutical microbiology at De Montfort University, said: “Bacteria are particularly good at adapting to their environment and through mutations in their DNA, which they are able to share with other bacteria, they can become resistant to antibiotics that are being utilised in healthcare environments.”
The DoH has produced posters, booklets and leaflets about the new strain, to try to prevent it spreading further.
There will also be a presentation at Keyll Darree Education and Training Centre in Strang, Douglas, on 17 January.
The World Health Organisation yesterday announced that the swine flu pandemic is over. Unfortunately, there is a new threat: NDM-1 bacteria.
Lancet Infectious Diseases reports that 50 cases of people infected with this new superbug – potentially more of a risk to hospital patients than the notorious MRSA – have so far been identified.
The researchers warn that the potential for NDM-1 bacteria to become endemic worldwide is “clear and frightening” and say we must develop new drugs to fight the threat now.
WHAT IS NDM-1?
NDM-1 is an enzyme produced by certain bacteria, which allows them to neutralise the harmful effects of carbapenems, one of the most powerful types of antibiotics available to doctors.
WHERE DID IT COME FROM?
The clue is in the name. New Delhi metallo-ß-lactamase-1 has been identified in UK patients who had recently travelled to India or Pakistan for medical treatment – often cosmetic surgery. When these people were later treated in UK or US hospitals, NDM-1 passed to other patients.
WHAT IS A SUPERBUG?
Antibiotics are our most effective weapon against bacterial diseases such as tuberculosis, cholera and Black Death. However, bacteria have been developing resistance to antibiotics since they were first used commercially in the 1930s. These ‘superbugs’ – such as Methicillin-resistant Staphylococcus aureus (MRSA) – use proteins called enzymes to neutralise antibiotics.
Scientists are continually trying to develop new classes of antibiotic to meet the threat of these superbugs in an ongoing arms race. NDM-1, which makes bacteria resistant to one of our most powerful antibiotic classes, carbapenems, is a particular worry because there are currently no new types of antibiotics in the development pipeline that will be effective against it.
WHAT IS THE THREAT?
Enzymes such as NDM-1 are produced by strands of DNA which bacteria are known to transfer between one another. Currently two bacteria have been host to the NDM-1 enzyme: Escherichia coli and Klebsiella pneumonia (above), both of which are found in the human gut and are normally harmless.
However, they can both cause urinary tract infections and blood poisoning, while the latter, as its name suggests, can cause pneumonia.
Professor David Livermore, from the Health Protection Agency, said: “These are not bacteria that are historically very harmful to humans, but medicine has got better at keeping people alive with conditions that would normally have killed them and they can be exploited by these bacteria.”
The worry is that the gene for NDM-1 production will be transferred to a type of bacterium that is resistant to all other antibiotics – and that is easily spread between patients. Such a development would constitute a nightmare scenario.
CAN IT BE TREATED AT ALL?
Patients with an NDM-1 infection can be treated with a cocktail of antibiotics, the idea being that it is unlikely a bacterium could be resistant to all of them.
However, researchers have found at least one NDM-1 bacterium that is resistant to all known antibiotics. The key to stopping the spread will be identifying new cases early and insisting on good hygiene in hospitals: disinfecting medical instruments and ensuring doctors and nurses wash their hands with antibacterial soap.
IS THIS A GLOBAL PROBLEM?
NDM-1 bacteria are widespread across the Indian subcontinent and have also been reported in the UK, US, Canada, Netherlands and Australia.
IS ANYONE DEVELOPING A CURE?
Most new antibiotics currently under development are effective only against gram-positive bacteria such as the more famous superbug MRSA. Unfortunately, bacteria that carry the NDM-1 enzyme are gram-negative.
The UK’s Health Protection Agency says: “Multi-resistant gram-negative bacteria pose a notable public health risk and it remains important that the pharmaceutical industry continues to work towards developing new treatment options”