CHP: Review Of NDM-1 In Hong Kong

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

# 6719

 

The Centre for Health Protection publishes a weekly Communicable Disease Watch, where they highlight recent infectious disease events in and around Hong Kong.

 

Today, they include a review of the resistance enzyme NDM-1 (New Delhi metallo-ß-lactamase-1) which was first detected in a patient in Sweden (albeit with Indian origins) four years ago, but has subsequently spread to many countries around the world.

 

This enzyme confers resistance to certain gram negative bacteria like E.coli and Klebsiella against a class of antibiotics called carbapenems. Carbapenems are often our drug of last resort against a variety of bacterial infections.

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

The rise of antibiotic resistance - including this emerging NDM-1 enzyme - has long been linked to the overuse and misuse of antibiotics. A practice that is still widespread in many parts of the world, but is particularly rampant on the Indian sub-continent.

 

Citing a lack of doctors and low family incomes, the Indian government (see India: Still Looking For A Policy On Antibiotics) has been slow to stop the sale of antibiotics to the public without a doctor’s prescription.

 

It’s been more than 2 years since The Lancet published a study (see NDM-1: A New Acronym To Memorize)  by Walsh, Toleman, Livermore, et al. that sounded the alarm on the emergence and growing prevalence of the NDM-1 enzyme on the Indian sub-continent.

 

Since that time, we’ve seen a slow, but inexorable spread of NDM-1 carrying bacteria around the globe. A few of my past blogs on the subject include:

 

Carbapenemases Rising

NDM-1: One Year Later

WHO Unveils 6-Point Plan To Preserve Antibiotic Effectiveness

Eurosurveillance On Antimicrobial Resistance

 

 

Today’s report from the HPC indicates that they have identified 17 patients carrying the NDM-1 enzyme over the past four years, with one case each in 2009 and 2010, three cases in 2011, and 12 cases so far in 2012.

 

Many of these cases were colonized and detected through routine screening, but were asymptomatic. As this report indicates:

 

Infections varied from colonisation or mild to potentially life threatening or fatal. The level of risk depends upon which body part is infected and general health of the patient.

 

I’ve included some excerpts, but follow the link to read:

 

 

Source CHP Communicable Disease Watch

Among the 17 cases, 13 (76%) were male, and the median age was 64 years (ranged from 11 months to 94 years). Fourteen (82%) were Chinese, 2 Indian and 1 Burmese.

 

Among 16 imported cases, all except one had history of admission to hospitals while staying abroad. Twelve were hospitalised in Mainland China (8 in Guangdong province, 2 in Hunan province, 1 in Fujian province and 1 in Henan province), one in India, one in Myanmar and one in Thailand. Six (40%) of them had operations done during their hospitalisation.

 

The one without history of admission to hospital was a 66-year-old male patient of Indian ethnicity and he had travelled to India before onset of symptoms. Four cases had signs of infection (2 had chest infection, 1 urinary tract infection and 1 leg infection). 

 

Thirteen were asymptomatic colonisation detected by screening or contact tracing. One had the bacteria yielded from both sputum and rectal swab specimens. Two cases passed away due to underlying illness and aspiration pneumonia respectively.

 

In September 2012, CHP identified an import-related NDM-1 case affecting a 64-year-old man. A rectal swab was taken for this patient as part of the contact tracing exercise for another imported NDM-1 patient (78-year-old man) from Myanmar. They had stayed in the same cubicle of a hospital ward in Hong Kong.

 

The rectal swab was tested positive for NDM-1. Pulsed-field gel electrophoresis patterns of the two NDM-1 strains were subsequently found to be identical by the Public Health Laboratory Services Branch (PHLSB) of CHP.

This suggests that the 64-year-old case was epidemiologically linked to the 78-year-old imported case. Thirteen other patients stayed in the same cubicles as the case patients for more than 48 hours were screened by rectal swabs and all were tested negative.

 

 

This week is antibiotic awareness week (see A Health Crisis In Slow Motion) here in the United States, as it is in many places around the world. The erosion of the effectiveness of our antimicrobial arsenal increases with each year, and leads many doctors and scientists to worry that we’ll eventually lose the ability to treat even common infections.

 

For a far more complete discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA. And Maryn’s SUPERBUG Blog, part of Wired Science Blogs, continues to provide the best day-to-day coverage of these issues.

»» Read More

India: Still Looking For A Policy On Antibiotics

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

# 6502

 

Although the antibiotic resistance enzyme now known as NDM-1 (New Delhi metallo-ß-lactamase-1) was first detected in a patient in Sweden (albeit with Indian origins) four years ago, it didn’t capture much attention until the publication of an eye-opening research paper in The Lancet in August of 2010.

 

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

Dr David Livermore, Prof Timothy Walsh, et al.

doi:10.1016/S1473-3099(10)70143-2

Published Online: 11 August 2010

 

This study linked the recent importation of a handful of NDM-1 infections into the UK, US, and other countries  to `medical tourism’ on the Indian Sub-continent (see NDM-1: A New Acronym To Memorize).

 

NDM-1 is an enzyme confers resistance to certain gram negative bacteria like E.coli and Klebsiella against a class of antibiotics called carbapenems. Carbapenems are often our drug of last resort against a variety of bacterial infections.

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

 

The rise of antibiotic resistance has long been linked to the overuse and misuse of antibiotics.

 

Citing a lack of doctors and low family incomes, the Indian government allows the unfettered sale of antibiotics to the public without a doctor’s prescription.

 

Indian officials swiftly reacted to the Lancet paper, but rather than taking immediate action against a growing public health menace, they took umbrage instead.

 

They condemned of the use of `New Delhi’ in the naming of this resistance gene and called the paper a `conspiracy theory’.  They issued broad denials of its prevalence in India or that medical tourism to their nation was responsible for its spread.

 

It is worth noting that the naming convention for pathogens that invoked India’s ire has long used the pathogen’s place of discovery or emergence. India was certainly not singled out.

 

After intense pressure from the International community and scathing editorializing in Indian newspapers, the Indian Health Ministry announced in October 2010 that they would impose new restrictions on the sale of 90 antibiotics that were currently sold over-the-counter.

 

But that plan was eventually abandoned. Two years later, the sale of antibiotics remains rampant and unregulated in India.

 

This article appeared last week in The Hindu.

 

 

Wanted: a policy on antibiotics

R. Sujatha

It needed a scare like NDM-1 for the country to wake up to a policy to regulate antibiotics. But after announcing with much fanfare that a policy would be in place, the government withdrew the decision. We have arrived at a crossroads and there is no solution to the crisis yet.

(Continue . . .)

 

 

The story goes on to say that next week doctors from around the country will meet in Chennai to try to come up some kind of  `road map’ for the government to use to implement an antibiotic policy. 

 

Whether they will succeed, and whether the government will follow through, remains to be seen.

 

Meanwhile, as policy makers dither, the NDM-1 enzyme continues its evolution and spread.

 

Six months after the first Lancet article in April, 2011, the same researchers published a another study that found the NDM-1 enzyme in 4% of New Delhi’s sampled drinking water sources, and 30 per cent of the sewage tested.

 

The Lancet Infectious Diseases, Early Online Publication, 7 April 2011

doi:10.1016/S1473-3099(11)70059-7

Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study

Prof Timothy R Walsh PhD , Janis Weeks BS, David M Livermore PhD , Mark A Toleman PhD

 

And most alarmingly, the researchers also identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

Once again the reaction out of India was one of denial (see Hopefully, It’s Just A Stage They Are Going Through). 

 

Last fall, despite ongoing denials from the Indian government, we saw a number of stories that helped to corroborate the findings of these two much-maligned-in-India Lancet studies.

 

First stop, the The Economic Times.

Ganga Ram study finds high levels of superbug NDM1

5 Oct, 2011, 1114 hrs IST, Durgesh Nandan Jha, TNN

NEW DELHI: India might have vehemently opposed an antibiotic-resistant superbug being named New Delhi Metallo-beta-lactamase 1 (NDM1), but a study in a leading city hospital has found a worryingly high prevalence of the deadly gene.

(Continue . . . )

 

 

The study, conducted over a 5-month period, examined 10,889 samples from patients. The NDM1 resistance gene was found in 8.1% of E. coli samples and 38.02% of samples of K. pneumoniae.

 

In the article, Dr S P Byotra, chairperson of medicine at the Ganga Ram Hospital, is quoted as saying:

 

"The idea behind this study is to stop denying the crisis NDM1 poses and work out strategies to check its spread. Antibiotic usage needs to be monitored strictly and good infection-control methods should be put in place at hospitals."

 

Another related article, that appeared in the International Business Times, quotes Former Indian Council of Medical Research chief and chairman N.K. Ganguly as saying that the multi-drug resistant New Delhi metallo-beta-lactamase-1 or NDM-1 comes from hospital waste that goes into Delhi's sewage water.

 

Presence of Antibiotic-Resistant Bacteria in Delhi Confirmed

October 5, 2011 1:26 PM EST

 

 

Last March (see Chan: World Faces A `Post-Antibiotic Era’), World Health Organization Director-General Margaret Chan – delivering the  keynote address to the Conference on Combating Antimicrobial Resistance in Copenhagen, Denmark - painted a bleak picture of the future of antibiotic availability if action is not taken.

 

The D-G’s entire remarks may be viewed on the WHO’s website at Antimicrobial resistance in the European Union and the world, but I’ve excerpted a few choice statements below, after which you’ll find a link to the World Health Organization’s latest publication on antibiotic resistance.

 

Excerpts from D-G Chan’s March 14th, 2012 speech.

 

Antimicrobial resistance is on the rise in Europe, and elsewhere in the world. We are losing our first-line antimicrobials. Replacement treatments are more costly, more toxic, need much longer durations of treatment, and may require treatment in intensive care units.

 

<SNIP>

 

If current trends continue unabated, the future is easy to predict. Some experts say we are moving back to the pre-antibiotic era. No. This will be a post-antibiotic era. In terms of new replacement antibiotics, the pipeline is virtually dry, especially for gram-negative bacteria. The cupboard is nearly bare.

 

<SNIP>

 

A post-antibiotic era means, in effect, an end to modern medicine as we know it. Things as common as strep throat or a child’s scratched knee could once again kill.

The evolving threat of antimicrobial resistance - Options for action

Authors:
World Health Organization

 

 

To be fair, India isn’t the only country with NDM-1 cases or growing carbapenem resistance. But the Indian sub-continent does appear to be a focal point – a situation often linked to their lax controls on the sale and use of antibiotics.

 

Short of seeing a hyper-virulent pandemic someday, I can think of no public health crisis with a bigger potential impact than the growth of antibiotic resistant pathogens.

 

While I dabble in the subject from time to time, without a doubt  the `go to’ blogger on all things antibiotic resistant is Maryn McKenna, author of Superbug: The Fatal Menace of MRSA. 

 

 

If you aren’t a regular visitor to her Superbug Blog, you should be.

 

If and when the Indian government imposes meaningful restrictions on the sale of antibiotics, I’ll report it. 

 

One just hopes that happens before the point becomes moot.

»» Read More

EID: Environmental NDM-1 Detected In Vietnam

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

# 6440

 

In a study reminiscent of one we saw published in April of last year (see Lancet Study: NDM-1 In New Delhi Water Supply), the CDC’s EID Journal has a letter by R. Isozumi et al. that appears (ahead of print) in their August issue, that reveals the detection of the NDM-1 gene in a river in Hanoi.

 

bla_NDM-1–positive Klebsiella pneumoniae from Environment, Vietnam

Rie Isozumi , Kumiko Yoshimatsu, Tetsu Yamashiro, Futoshi Hasebe, Binh Minh Nguyen, Tuan Cuong Ngo, Shumpei P. Yasuda, Takaaki Koma, Kenta Shimizu, and Jiro Arikawa

 

By way of explanation, bla_NDM-1 is the gene responsible for creating the NDM-1 (New Delhi metallo-β-lactamase) enzyme that can make many types of bacteria resistant to a wide spectrum of antibiotics.

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

Over the past few years we have seen a worrisome expansion of β-lactamase enzymes in bacteria, and they are slowly eroding the value of much of our antibiotic arsenal.

 

Those that inhibit the antimicrobial actions of the (formerly resistant) Carbapenem class of antibiotics – called carbapenemases – are of particular concern. Carbapenems are often used as the drug of last resort for treating difficult bacterial infections, including Escherichia coli (E. coli) and Klebsiella pneumoniae.

 

So when the gene responsible for the NDM-1 enzyme begins to show up in the environment, doctors and researchers take notice.

 

The author’s of today’s EID Journal report state their reasons for concern:

 

The possible appearance of bacteria harboring bla_NDM-1 in Vietnam is of concern because cultural and economic links between Vietnam and India are strongly established, including extensive person-to-person exchanges that could enable easy exchange of pathogens. In addition, Vietnam faces a serious problem of antimicrobial drug resistance because drugs are freely available and used in an indiscriminate fashion. Thus, once bla_NDM-1–positive bacteria colonize persons in Vietnam, they would be able to spread easily and pose a serious public health threat.

 

To look for environmental bla_NDM-1, researchers examined water samples taken from 20 locations within 10 km of Hanoi, Vietnam. Samples were collected from rivers, lakes, and standing water in the streets.

The authors report finding the NDM-1 enzyme producing gene in two locations – 3km apart – in the Kim Nguu River, which flows through the city.  They write:

 

We harvested several species of bacteria from the 2 seepage samples positive for bla_NDM-1: Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, P. fluorescens/putida, and P. luteola. 

 

They also report finding 2 other βeta-lactamases (bla_TEM-1 and bla_CTX-M-3) that were highly resistant to another class of antibiotics called aminoglycosides (which include neomycin, streptomycin & tobramycin)

The authors conclude by saying:

Wide-scale surveillance of environmental and clinical samples in Vietnam and establishment of a strategy to prevent further spread of bla_NDM-1 are urgently needed.

It’s been nearly 2 years since The Lancet published a study (see NDM-1: A New Acronym To Memorize)  by Walsh, Toleman, Livermore, et al. that awakened the world to the  emergence and growing prevalence of the NDM-1 enzyme.

 

Since that time, we’ve seen a slow, but inexorable spread of NDM-1 carrying bacteria around the globe. A few of my past blogs on the subject include:

 

Carbapenemases Rising

NDM-1: One Year Later

WHO Unveils 6-Point Plan To Preserve Antibiotic Effectiveness

Eurosurveillance On Antimicrobial Resistance

 

For a far more complete discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA. And Maryn’s SUPERBUG Blog, part of Wired Science Blogs, continues to provide the best day-to-day coverage of these issues.

 

Last March, Director-General of the World Health Organization Margaret Chan warned that the World Faces A `Post-Antibiotic Era’. One where even common infections may become untreatable.

 

While we aren’t there yet, reports such as the one today in the EID Journal add to the growing concern that someday, that fear may become a reality.

»» Read More

MMWR: NDM-1 Transmission In Rhode Island

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

 

# 6397

 

From the today’s MMWR , we’ve a report on the importation and likely nosocomial transmission of a CRE (carabapenem-resistant Enterobacteriaceae) infection containing NDM-1.

 

NMD-1, or New Delhi metallo-ß-lactamase-1 – is an enzyme which confers broad antibiotic resistance to various types of bacteria. Even more troubling, it rides on a plasmid (a snippet of portable DNA) that can be shared by different types of bacteria.

 

The good news is that NDM-1 cases in the United States are still rare enough that they merit extensive reportage in the CDC’s MMWR. The bad news is, they continue to spread around the globe and our treatment options against them are extremely limited.

 

A few excerpts from today’s MMWR report follow (slightly reparagraphed for readability). 

 

 

Carbapenem-Resistant Enterobacteriaceae Containing New Delhi Metallo-Beta-Lactamase in Two Patients — Rhode Island, March 2012

 

June 22, 2012 / 61(24);446-448

U.S. and international efforts to control carabapenem-resistant Enterobacteriaceae (CRE) are critical to protect public health. Clinicians caring for patients infected with such organisms have few, if any, therapeutic options available. CRE containing New Delhi metallo-beta-lactamase (NDM), first reported in a patient who had been hospitalized in New Delhi, India, in 2007 (1), are of particular concern because these enzymes usually are encoded on plasmids that harbor multiple resistance determinants and are transmitted easily to other Enterobacteriaceae and other genera of bacteria (2).

 

A urine specimen collected on March 4, 2012, from a patient who recently had been hospitalized in Viet Nam, but who was receiving care at a hospital in Rhode Island, was found to have a Klebsiella pneumoniae isolate containing NDM.

 

The isolate was susceptible only to tigecycline, colistin, and polymyxin B. Point-prevalence surveys of epidemiologically linked patients revealed transmission to a second patient on the hematology/oncology unit.

 

These two cases bring to 13 the number of cases of NDM reported in the United States. After contact precautions were reinforced and environmental cleaning was implemented, no further cases were identified.

 

<SNIP Lengthy Narrative On Patients, Lab Tests, and Isolation Methods>

 

Reported by

Erica E. Hardy, MD, Leonard A. Mermel, DO, Dept of Medicine, Kimberle C. Chapin, MD, Dept of Pathology, Warren Alpert Medical School of Brown Univ; Cindy Vanner, Rhode Island Dept of Health. Ekta Gupta, MD, Dept of Medicine, Boston Univ School of Medicine, Massachusetts. Corresponding contributor: Leonard A. Mermel, lmermel@lifespan.org, 401-444-2608.

Editorial Note

Since the first report in 2009, cases involving NDM-producing Enterobacteriaceae have been reported in every continent except South America and Antarctica (7). Among 29 cases in the United Kingdom, at least 17 involved patients who had traveled to India or Pakistan, among whom 14 had been hospitalized in one of those countries (8).

 

Although medical care in the Indian subcontinent was associated with many early reports, recent cases have been described involving persons who traveled to endemic regions* but were not hospitalized (7). The plasmid-carrying NDM is highly transmissible to other bacteria, and bacteria carrying NDM can colonize the gastrointestinal systems of humans for prolonged periods and can spread through contamination of water sources and environmental surfaces (7).

 

Not surprisingly, nosocomial spread also has been documented outside of the Indian subcontinent. Of 77 cases of infection or colonization with CRE containing NDM in Europe, 13 might have been hospital-acquired in Europe (9). Spread of NDM in other parts of Asia also has been reported, including four patients in South Korea without travel history (10), similar to recent reports elsewhere (7).

 

(Continue . . . )

 

 

In summary, the report offers the following:

 

What is already known on this topic?

New Delhi metallo-beta-lactamase (NDM)–producing Klebsiella pneumoniae are resistant to extended-spectrum antimicrobials, including carbapenems. The resistance mechanism is highly transmissible and its presence substantially limits treatment options. NDM-producing Enterobacteriaceae have been identified in the United States, primarily among patients with exposure to health care in endemic countries.

 

What is added by this report?

An NDM-producing organism was isolated from a patient being treated in the United States after having been hospitalized in Vietnam. Implementation of CDC-recommended carbapenem-resistant Enterobacteriaceae (CRE) control practices, including surveillance cultures of epidemiologically linked contacts, identified likely transmission to one other patient on the same ward of the U.S. hospital. Additional control measures were applied and additional surveillance and clinical cultures have not identified further transmission.

 

What are the implications for public health practice?

An aggressive approach to control of CRE, including highly transmissible carbapenemase-producing organisms, is essential to slow the spread of these organisms in the United States. In an outbreak, use of surveillance cultures to identify asymptomatic transmission potentially is an important part of these efforts.

 

 

I  wrote about this emerging public health threat less than a week ago, in NDM-1: A Matter Of Import. The following link will provide a list of some of my past blogs on the NDM-1 enzyme.

 

Without a doubt  the `go to’ blogger on all things antibiotic resistant is Maryn McKenna, author of Superbug: The Fatal Menace of MRSA. If you aren’t a regular visitor to her Superbug Blog, you should be.

 

Last March, Director-General of the World Health Organization Margaret Chan warned that the World Faces A `Post-Antibiotic Era’.

 

One where even common infections may become untreatable.

 

While we aren’t there yet, reports such as this one add to the growing concern that someday, that fear may become a reality.

»» Read More

NDM-1: A Matter Of Import

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

# 6390

 

It’s been nearly 2 years since The Lancet published a study (see NDM-1: A New Acronym To Memorize)  by Walsh, Toleman, Livermore, et al. on the emergence and growing prevalence a new enzyme – dubbed NDM-1 (New Delhi metallo-ß-lactamase-1) - on the Indian sub-continent that can confer resistance to certain gram negative bacteria like E.coli and Klebsiella against a class of antibiotics called carbapenems.

 

Carbapenems are newer generation beta-lactam antibiotics (a class that includes penicillins, cephalosporins, cephamycins, and carbapenems) that are usually reserved as an antibiotic of last resort.

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

While the numbers were small, the authors identified a handful of patients in the UK who had recently travelled to the Indian Subcontinent and who returned with this resistant bacteria.

 

The reaction from officials out of India was both swift and disappointing. Rather than taking immediate action against a growing public health threat, they took umbrage instead.

 

They condemned of the use of `New Delhi’ in the naming of this resistance gene, called the paper a `conspiracy theory’, and issued broad denials of its prevalence in India or that medical tourism to their nation was responsible for its spread.

 

Under mounting pressure from the International community and editorializing in Indian newspapers, the Indian Health Ministry announced in October 2010 that they would impose new restrictions on the sale of 90 currently over-the-counter antibiotics.

 

But as the Deccan Chronicle reported as recently as last month, in an article called Medical body demands ban on 33 drugs in India (published May 20, 2012), little progress has been made:

 

Sale of antibiotics without prescription is rampant

Despite the government regulations restricting the sale of drugs without a prescription, medical stores continue to do so in the absence of active government monitoring. In particular, antibiotics can be obtained at medical stores just by naming them. Doctors say such an unchecked sale of antibiotics is harmful from the public's perspective.

 

Even though the policy framework of the Directorate General of Health Services seeks to regulate the unauthorised sale of antibiotics, the practice is rampant.

 

 

Six months after the first Lancet article - in April, 2011 - the same researchers published another study that found the NDM-1 enzyme in 4% of New Delhi’s sampled drinking water sources, and 30 per cent of the sewage tested.

 

The Lancet Infectious Diseases, Early Online Publication, 7 April 2011

doi:10.1016/S1473-3099(11)70059-7

Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study

Prof Timothy R Walsh PhD , Janis Weeks BS, David M Livermore PhD , Mark A Toleman PhD

 

 

And most alarmingly, the researchers also identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

 

Today the VOA (Voice of America) carries a report on the growing concerns over the spread of Drug Resistant bacteria across India. A problem exacerbated not only by the unregulated sale of antibiotics over the counter, but also by a lack of waste treatment facilities in that country of more than 1 billion people.

 

Concerns Mount Over India's Role In Incubating Drug-Resistant Bacteria

Kurt Achin

May 16, 2012

Medical research is once again pointing to India as a dangerous crucible of bacterial strains that resist many forms of antibiotic treatment. Cheap, under-regulated antibiotics and a severe shortfall of sanitation infrastructure fuel the problem.

 

<SNIP>

 

Unsanitary conditions in India are blamed for creating an environment for superbugs - both in emerging megacities, and in rural locations where toilet infrastructure is nearly nonexistent.

Nitya Jacob, head of water issues at New Delhi's Center for Science and Environment, co-authored a recent study called “Excreta Matters.”

"India has a capacity to treat only about a fifth of its sewage and I think about 40 percent of that capacity is concentrated in just two cities of Delhi and Bombay," said Jacob.

Superbug researcher Kumarasamy says the Indian government needs to act urgently to prevent the spread of drug-resistant diseases.

(Continue . . .)

 

More detail on the Excreta Matters study, referenced above, can be found on the Centre For Science and Environment website.

 

 

Meanwhile, as governments dither and regulations go unenforced - superbugs like NDM-1, acinetobacter, and a myriad of carbapenamases including: IMP, VIM, OXA, CMY, and most notably KPC (K. pneumoniae carbapenemase) - continue their pernicious spread around the world.

 

A story out of Edmonton, Canada last week illustrates this point, showing just how easily superbugs can be imported, and then spread:

 

Health officials admit superbug lead to death of patient at Royal Alex

Updated: Wed Jun. 06 2012 19:18:56
Julia Parrish, ctvedmonton.ca

Weeks after two types of drug resistant bacteria were brought into Edmonton by a woman who had surgery overseas, health officials have confirmed those `superbugs' lead to the death of another patient at the Royal Alexandra Hospital.

(Continue . . . )

 

 

Short of seeing an extremely high mortality influenza pandemic, I can think of no looming medical crisis more dire than the growing threat of antimicrobial resistance. The World Health Organization, the ECDC, and the CDC all consider the spread of antibiotic resistant organisms to be an extremely urgent public health concern.

 

For more on these issues, you may wish to revisit:

 

Carbapenemases Rising

Chan: World Faces A `Post-Antibiotic Era’

WHO: The Evolving Threat Of Antimicrobial Resistance

 

 

And for a far more complete (and eye-opening) discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA.

 

And Maryn’s SUPERBUG Blog, part of Wired Science Blogs, continues to provide the best day-to-day coverage of these issues.

»» Read More

The Passing Parade Of 2011 – Pt. 2

 

 

 

# 6036

 

Over the past year I’ve posted more than 900 blogs, dozens of which looked at some of the latest research into influenza and other emerging infectious diseases.

 

Since these studies oft times make an initial splash only to get lost in the passing parade of new reports, today I’ve some brief summaries (with links back to the original blogs) on some of the research of 2011 I believe is deserving of a second look.

 

This is the second such roundup, the first one may be accessed at this link.

 

 

Last April in Lancet Study: NDM-1 In New Delhi Water Supply, we saw a report authored by Timothy Walsh, Janis Weeks , David M Livermore, and Mark A Toleman that looked for – and found – bacteria carrying the NDM-1 enzyme in New Delhi's drinking water supply.

 

We’ve a press release on this study, issued by Cardiff University, that gives the highlights of the research, but the `money quote’ (emphasis mine) buried about halfway down is:

 

Resistant bacteria were found in 4 per cent of the water supplies and 30 per cent of the seepage sites. The researchers identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

Below is a link to the Lancet study, which you can read in its entirety (a free registration is required).

 

 

The Lancet Infectious Diseases, Early Online Publication, 7 April 2011

doi:10.1016/S1473-3099(11)70059-7

Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study

Prof Timothy R Walsh PhD , Janis Weeks BS, David M Livermore PhD , Mark A Toleman PhD

 

Again in April, we saw research seeking to answer the question over why there was such a wide variance in death rates around the world with the 1918 Spanish influenza. 

 

In 2006, in a Lancet journal (doi:10.1016/S0140- 6736(06) 69895-4) article cited as much as a 30-fold difference in mortality rates around the world:

 

Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918—20 pandemic: a quantitative analysis

Christopher JL Murray , Alan D Lopez , Brian Chin , Dennis Feehan , Kenneth H Hill

Excess mortality ranged from 0·2% in Denmark to 4·4% in India. Since there was some under-registration of mortality in India, total pandemic mortality could have been even higher.

 

 

This wide disparity in mortality rates – much of it based on anecdotal accounts – has long intrigued researchers.  This new study from the Norwegian Institute of Public Health that attempts to answer some of these questions.

 

What they found was that the mortality rate varied nearly 100 fold between remote, rural regions and urban populations, and that in the more remote areas, older persons were just as susceptible to the virus as those who were younger.

 

This study appears in the Journal Epidemics.

Geography May Explain Adult Mortality from the 1918–20 Influenza Pandemic

Original Research Article
Pages 46-60
Svenn-Erik Mamelund

 

The theory that a similar H1 virus circulated prior to 1890 – and that provided some immunity to those over the age of 30 – is bolstered by this study.

 

 

Given the current flap over the H5N1 experiments conducted by Ron Fouchier in the Netherlands and Yoshihiro Kawaoka  at the University of Wisconsin (see The Biosecurity Debate On H5N1 Research) the next two studies deserve a second look as well.

 

 

Simplified Illustration of a Serial Passage Experiment. 

 

In H5N1: A Rite Of Passage we looked at how serial passage studies are conducted, and at one in particular that appeared in the Journal of Animal and Veterinary Advances that looked at increases in pathogenicity (in mice) of two H5N1 viruses after six serial passages in quail.

 

The study is called:

 

The Pathogenicity Variation of Two Quail-Origin H5N1 HPAV to BALB/c Mice after Six Passages in Quail

Hailiang Sun, Peirong Jiao, Yuqiang Cheng, Runyu Yuan, Pengfei Cui, Liming Jin, Chaoan Xin and Ming Liao

 

Another study, profiled in PNAS: Reassortment Potential Of Avian H9N2, looked at the reassortment potential of the avian H9N2 virus and H1N1. Research was done using ferrets whose respiratory physiology is considered relatively close to humans.

 

Compatibility of H9N2 avian influenza surface genes and 2009 pandemic H1N1 internal genes for transmission in the ferret model

J. Brian Kimble, Erin Sorrell,  Hongxia Shao,  Philip L. Martin, and Daniel Roberto Perez

 

(Excerpt from the abstract)

Four reassortant viruses were generated, with three of them showing efficient respiratory droplet transmission. Differences in replication efficiency were observed for these viruses; however, the results clearly indicate that H9N2 avian influenza viruses and pH1N1 viruses, both of which have occasionally infected pigs, have the potential to reassort and generate novel viruses with respiratory transmission potential in mammals.

 

 

The entire study is available online, and open access.

 

 

And in Study: Prior Antibiotic Use & MRSA In Children Canadian researchers, examining 13 years worth of data from the UK’s General Practice Research Database (GPRD), came up with what they called  a `robust association’ between a prior history of antibiotic use and rates of CA-MRSA (Community Acquired Methicillin Resistant Staph Aureus) infection in children.

The study appeared Aug. 1st  in the Archives of Pediatrics & Adolescent Medicine.

 

Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children

Verena Schneider-Lindner, MD, MSc; Caroline Quach, MD, MSc; James A Hanley, PhD; Samy Suissa, PhD

Arch Pediatr Adolesc Med. Published online August 1, 2011. doi:10.1001/archpediatrics.2011.143

 

What these researchers found was that while nearly half of children with MRSA in this study had no recent history of antibiotic use, the adjusted relative risk (RR) of developing MRSA was 3.5 times higher among children who had received antibiotic treatment in the previous 30-180 days before infection.

 

And that relative risk increased substantially among children who received more than one course of antibiotics.

 

To find more blogs specific to research you can use the RESEARCH quick link on my sidebar.

 

As news is often slow during the holiday season, over the next couple of weeks I plan to post one or two more retrospectives on the news and research of the year that was.

»» Read More

Referral: McKenna On NDM-1 In India

 

 

# 5903

 

 

Maryn McKenna, author of Superbug: The Fatal Menace of MRSA, has details on the political and scientific wrangling surrounding the recent international conference on antibiotic resistance held last week in New Delhi (see my posts here, and here).

 

Follow the link below to go to Maryn’s Superbug Blog.

 

NDM-1 in India: Drug Resistance, Political Resistance

• By Maryn McKenna
• October 16, 2011  | 
• 10:14 am  | 
•  

»» Read More

India: The NDM-1 Story Continues

 

 

# 5880

 

 

In a follow up to Monday’s blog on the failure of the Indian government to restrict the over-the-counter sale of antibiotics, we’ve several news stories this morning that emphasize just how quickly NDM-1 and other forms of antibiotic resistance are spreading on the Indian subcontinent.

 

Many of these stories, no doubt, are inspired by this week’s global summit on antibiotic resistance being held in New Delhi. 

 

NDM-1, or New Delhi metallo-ß-lactamase-1, is an enzyme that confers antibiotic resistance to several common types of bacteria. This emerging form of antimicrobial resistance made huge headlines in a Lancet study in August of last year:

 

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

Since then, sporadic NDM-1 cases have been identified in countries around the world, with the vast majority of them having some link to a previous medical procedure or treatment in India or Pakistan.

 

The Indian government’s response was first to deny that a problem with NDM-1 existed and to take serious umbrage over the naming of the pathogen. 

 

Under pressure to act, promises to restrict the sale of antibiotics were made in October of last year, but have yet to be implemented.

 

Again in April of this year, The Lancet published another study by Timothy Walsh, Janis Weeks , David M Livermore, and Mark A Toleman that looked for – and found – bacteria carrying the NDM-1 enzyme in New Delhi's drinking water supply.

 

Lancet Study: NDM-1 In New Delhi Water Supply

 

A snippet from the press release stated ominously (emphasis mine):

 

Resistant bacteria were found in 4 per cent of the water supplies and 30 per cent of the seepage sites. The researchers identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

In an interview for Reuters, co-author Mark Toleman of Britain’s Cardiff University School of Medicine stated that as many as 500,000 residents of New Delhi may be carrying the NDM-1 resistance gene in their gut flora.

 

The response from the Indian government, again, was one of denial (see Hopefully, It’s Just A Stage They Are Going Through).

 

Indian officials claimed that the researchers `illegally transferred’ samples of tap water out of the country, stated that the research was `unscientific’ and insist that the researchers were intentionally biased.

 

 

Which brings us to several stories this morning that go a long ways towards confirming many of the findings of these two much-maligned-in-India Lancet studies.

 

First stop, the The Economic Times.

 

Ganga Ram study finds high levels of superbug NDM1

5 Oct, 2011, 1114 hrs IST, Durgesh Nandan Jha, TNN

NEW DELHI: India might have vehemently opposed an antibiotic-resistant superbug being named New Delhi Metallo-beta-lactamase 1 (NDM1), but a study in a leading city hospital has found a worryingly high prevalence of the deadly gene.

(Continue . . . )

 

The study, conducted over a 5-month period, examined 10,889 samples from patients. The NDM1 resistance gene was found in 8.1% of E. coli samples and 38.02% of samples of K. pneumoniae.

 

In the article, Dr S P Byotra, chairperson of medicine at the Ganga Ram Hospital, is quoted as saying:

 

"The idea behind this study is to stop denying the crisis NDM1 poses and work out strategies to check its spread. Antibiotic usage needs to be monitored strictly and good infection-control methods should be put in place at hospitals."

 

Next, a related article in the International Business Times, that quotes Former Indian Council of Medical Research chief and chairman N.K. Ganguly saying that the multi-drug resistant New Delhi metallo-beta-lactamase-1 or NDM-1 comes from hospital waste that goes into Delhi's sewage water.

 

Presence of Antibiotic-Resistant Bacteria in Delhi Confirmed

October 5, 2011 1:26 PM EST

 

Another story, this time from IBN-Live, states that 60,000 newborns die each year in India due to various types of antibiotic resistant sepsis (including NDM-1).

 

Health | Updated Oct 05, 2011 at 11:48am IST

NDM-1 superbug hits neonatal ICUs, kills infants

 

 

And lastly, filed under the category of no-good-deed-goes-unpunished, two of the authors of the original Lancet study – Dr Timothy R. Walsh and Dr Mark Toleman – report a decidedly cool reception at this week’s global summit in New Delhi.

 

Savita Verma  New Delhi, October 5, 2011 | 

UK 'superbug' scientist-duo alleges boycott by Indian counterparts

 

Despite hosting a global summit this week, India still appears to be treating NDM-1 and antibiotic resistance as a public relations problem instead of a public health threat.

 

To be fair, India isn’t the only country with NDM-1 cases or growing carbapenem resistance. But the Indian sub-continent does appear to be a focal point – a situation often blamed on their longstanding lax controls on the use of antibiotics.

 

 

Short of seeing an extremely high mortality influenza pandemic, I can think of no looming medical crisis more dire than the growing threat of antimicrobial resistance.

 

The World Health Organization (WHO) and the CDC - along with other public health organizations around the world – used this year’s World Health Day – 7 April 2011 to promote sane antibiotic usage and awareness of antimicrobial resistance.

 

 

Given the these reports (and many others), increased surveillance, openness, and international cooperation – not indignation, intimidation, and denial – are the responses needed if we are to have any hope of stemming the rise of antibiotic resistance around the globe.

 

And we need these things now, as time is not exactly on our side.

»» Read More

India Puts Antibiotic Regulations On Hold

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

# 5877

 

 

In August of 2010 a research article was published in The Lancet on the emergence on the Indian sub-continent (and its recent importation into the UK, US, and other countries) of a particularly worrisome enzyme that confers antibiotic resistance to common bacteria (see NDM-1: A New Acronym To Memorize).

 

This enzyme was dubbed NMD-1 or New Delhi metallo-ß-lactamase-1, using a long-standing convention for naming pathogens that often incorporates its place of discovery or emergence.

 

The reaction from officials out of India was both swift and disappointing. 

 

Rather than taking steps against a growing public health threat, they condemned of the use of `New Delhi’ in the naming of this enzyme, dismissed the findings, and called the paper a `conspiracy theory’.

 

The first `action’ that many scientists hoped the Indian government would take would be to end the unrestricted sale of antibiotics at local pharmacies. 

 

Over the following two months a chorus of international calls for action, along with highly critical Indian press coverage, finally resulted in a grudging agreement to regulate the sale of dozens of common antibiotics.

 

In NDM-1 Updates From India, I carried the following news report from the Indian news service DNA (Daily News & Analysis).

 

Superbug fallout: Antibiotics ‘on counter sale’ ceased

Published: Saturday, Oct 30, 2010, 9:00 IST

By Akanksha Bafna | Place: Mumbai | Agency: DNA

The drug controller general of India (DCGI) on Friday introduced new rules to buy antibiotics. According to the revised rules, a patient will need two copies of a prescription - one which will be in the chemist's custody.

(Continue . . .)

 

 

While this headline made these rules look like a fait accompli, in fact, they were not immediately enforced.

 

Over the next 10 months we saw a long list of reports out of India on the detection of NDM-1 and other resistant bacteria, yet as of mid-August of 2011 (see NDM-1: One Year Later) these new restrictions on the sale of antibiotics were still to be enforced.

 

Today, we’ve news that India’s Health Ministry continues to consider the impact of such regulations, and has not decided whether, and how, they will enforce them.

 

First stop, a press release from the Government of India’s Press Information Bureau on a forum being held in New Delhi on bacterial resistance.

 

 

Antimicrobial Resistance A Global Problem – Our Solutions Need to be Sensitive to Local Constraints: Azad

The Union Minister for Health & Family Welfare, Shri Ghulam Nabi Azad inaugurated today the “1st Global Forum on Bacterial Infections: Balancing Treatment, Access and Antibiotic Resistance” organized in New Delhi.

 

Speaking on the occasion, Shri Azad said “Antimicrobial Resistance poses a growing threat to the treatment and control of infectious diseases. It is now time to look into this problem more holistically. Resistance to micro-organisms leads to loss of lives, productivity and earnings, and also threatens to undermine the effectiveness of health delivery programmes in all Member States”. He said there is an urgent need to formulate and implement effective strategies to prevent and contain antimicrobial resistance and preserve the efficacy of antimicrobial drugs.

 

The Minister noted that “For a large country like India where a significant fraction lacks access to basic healthcare and antibiotics, we have an urgent need to protect the effectiveness of our most affordable drugs”. He informed that India has created an antibiotics policy that will restrict access to new generation antibiotics over the counter, restrict use for sub-therapeutic purposes in the animal feed sector and will focus on various measures to reduce the need for antibiotics.

 

Shri Azad asked the forum to debate the feasibility of a separate schedule H1 under the Drugs and Cosmetics Rules to rationalize and regulate antibiotics in the market, keeping in view the ground realities of particularly the rural India. The Minister acknowledged that the Ministry of Health and Family Welfare has received representations from various stakeholders and a balanced view in the matter would be taken. Shri Azad said “although resistance is global problem, shared by developing and developed countries, our solutions must be local and sensitive to constraints of respective health systems”.

 

Not explicitly stated in this press release is that while `India has created an antibiotics policy that will restrict access to new generation antibiotics over the counter’ . . . these regulations are not being enforced.

 

From DNA (Daily News & Analysis) we get a bit more clarification, with this report:

 

Govt holds antibiotic policy, not to restrict access to drugs

Published: Monday, Oct 3, 2011, 

 

 

The DNA report states that the government has put enforcement of their new antibiotics policy on hold until a way can be found to provide access to antibiotics for rural populations who may not have access to doctors.

 

And this is, no doubt, a legitimate concern. Access to doctors, and the ability to pay to see one, often elude the rural poor in India.

 

One proposal being considered involves training chemists and non-physician healthcare providers in rural areas so that they can prescribe antibiotics.

 

But lobbying and protests by pharmaceutical companies, drugstore retailers, online pharmacies, and agricultural interests also appear to be part of the delay.

 

For now, massive amounts of antibiotics continue to be sold freely over the counter across India, and we’ve no word of when these issues are expected to be resolved.

 

 

 

While the end of the antibiotic era is not yet at hand, many experts fear we may be drawing closer to that day.

 

In April of this year, Margaret Chan – Director General of the World Health Organization – in a speech for World Health Day 2011, issued this stark warning:

 

In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.

 

The implications go beyond a resurgence of deadly infections to threaten many other life-saving and life-prolonging interventions, like cancer treatments, sophisticated surgical operations, and organ transplantations. With hospitals now the hotbeds for highly-resistant pathogens, such procedures become hazardous.

 

While there are legitimate concerns over the impact that enforcing India’s new antibiotic rules might have, we are literally in a race against a rising tide of rising antibiotic resistance, and delays in curbing inappropriate antibiotic use endangers all of us. 

 

For a far more complete (and eye-opening) discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA.

 

And Maryn’s SUPERBUG Blog, now part of Wired Science Blogs, continues to provide the best day-to-day coverage of these issues.

»» Read More

NDM-1: One Year Later

 

 

# 5751

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

Although the antibiotic resistance enzyme now known as NDM-1 (New Delhi metallo-ß-lactamase-1) was first detected three years ago in a Swedish patient (with Indian origins), its notoriety truly didn’t begin until one year ago today with the publication of a controversial, and eye-opening research paper in The Lancet.

 

The NDM-1 enzyme confers resistance to certain gram negative bacteria like E.coli and Klebsiella against a class of antibiotics called carbapenems. And Carbapenems are often our drug of last resort against a variety of bacterial infections.

 

Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA  - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).

 

One year ago, the following research article was published in the Lancet on its growing prevalence on the Indian sub-continent and its recent importation into the UK, US, and other countries (see NDM-1: A New Acronym To Memorize).

 

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

Dr David Livermore, Prof Timothy Walsh, et al.

doi:10.1016/S1473-3099(10)70143-2

Published Online: 11 August 2010

 

 

The reaction from officials out of India was both swift and disappointing. Rather than taking immediate action against a growing public health threat, they took umbrage instead.

 

They condemned of the use of `New Delhi’ in the naming of this resistance gene, called the paper a `conspiracy theory’, and issued broad denials of its prevalence in India or that medical tourism to their nation was responsible for its spread.

 

It is worth noting that the naming convention for pathogens that invoked so much ire traditionally incorporates its place of discovery or emergence.

 

In 2001 a similar gene was discovered in Brazil and was dubbed SPM-1 (Sao Paulo metallo-beta-lactamase). Another, discovered in 1999 in Italy, is called VIM (Verona integron-encoded metallo-β-lactamase), while SIM stands for Seoul imipenemase found in Korea.

 

The day after this paper was published Health agencies around the world began voicing their concerns over the emergence of this new form of antibiotic resistance (see Public Health Agencies On NDM-1).

 

Under pressure from the International community and editorializing in Indian newspapers, the Indian Health Ministry announced in October 2010 that they would impose new restrictions on the sale of 90 currently over-the-counter antibiotics.

 

But as of today, amid strenuous protests from pharmacies, those restrictions have yet to be enforced according to this article in the Times of India.

 

With the specter of a new, more virulent, emerging forms of antibiotic resistance on the horizon, last fall the ECDC and EMEA produced a 54 page joint technical report called The Bacterial Challenge: Time To React to coincide with European Antibiotic Awareness Day in November 2010.

 

 

The World Health Organization (WHO) and the CDC - along with other public health organizations around the world – used this year’s World Health Day – 7 April 2011 to promote sane antibiotic usage and awareness of antimicrobial resistance.

 

 

Six months after the first Lancet article in April, 2011, the same researchers published a new study that found the NDM-1 enzyme in 4% of New Delhi’s sampled drinking water sources, and 30 per cent of the sewage tested.

 

The Lancet Infectious Diseases, Early Online Publication, 7 April 2011

doi:10.1016/S1473-3099(11)70059-7

Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study

Prof Timothy R Walsh PhD , Janis Weeks BS, David M Livermore PhD , Mark A Toleman PhD

 

And alarmingly, the researchers also identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.

 

Once again the reaction out of India was one of denial (see Hopefully, It’s Just A Stage They Are Going Through). 

 

One year after the Lancet report on the spread of NDM-1 out of India and Pakistan, concerns over its emergence and spread have not diminished. While the end of the antibiotic era is not yet at hand, the fear is we may be drawing closer to that day.

 

In April of this year, Margaret Chan – Director General of the World Health Organization – in a speech for World Health Day 2011, issued this stark warning:

 

In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.

 

The implications go beyond a resurgence of deadly infections to threaten many other life-saving and life-prolonging interventions, like cancer treatments, sophisticated surgical operations, and organ transplantations. With hospitals now the hotbeds for highly-resistant pathogens, such procedures become hazardous.

 

 

Short of seeing an extremely high mortality influenza pandemic, I can think of no looming medical crisis more dire than the growing threat of antimicrobial resistance. 

 

For more on these issues, you may wish to revisit:

 

Carbapenemases Rising

Eurosurveillance On Antimicrobial Resistance

WHO: The Threat Of Antimicrobial Resistance

 

And for a far more complete (and eye-opening) discussion of antimicrobial resistance issues, I can think of no better primer than Maryn McKenna’s book SUPERBUG: The Fatal Menace of MRSA.

 

And Maryn’s SUPERBUG Blog, part of Wired Science Blogs, continues to provide the best day-to-day coverage of these issues.

»» Read More