superbug
TRANSCRIPT
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