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Study Claims Highly Resistant Superbug Spreading From South Asia

The gene was found in British patients who had traveled to India and Pakistan for plastic surgery and other medical procedures.
WASHINGTON -- On August 10, the World Health Organization (WHO) announced the end of a global health threat: The H1N1 virus, or swine flu, was no longer a pandemic.

But just 24 hours later, the world learned of a new threat, in the form of a superbug that could spread around the world, transforming existing bacteria into highly resistant forms.

And there are almost no drugs to treat it.

This new superbug, according to the British medical journal "Lancet," contains a gene that can jump between bacteria, making them nearly impervious to antibiotics.

"What's happening as this resistance spreads, is that infections caused by these bacteria become much harder to treat," said David Livermore, who tracks antibiotic resistance at Britain's Health Protection Agency and who co-authored the study cited in the journal. "Usually there are still one or two antibiotics that remain active, but we're scraping the bottom of the barrel."

Tummy Tuck, Then?

The gene, known as New Delhi Metallo-beta-lactamase, or NDM-1, was found in British patients who had traveled to India and Pakistan for plastic surgery and other medical procedures. It was first identified last year in a Swedish patient who had spent time in an Indian hospital.

NDM-1 makes bacteria highly resistant to almost all antibiotics, including the most powerful class, called carbapenems, which are usually reserved for emergency use and to treat other drug-resistant infections.

According to the new study, the occurrence of the gene -- and the supercharged infections that it causes -- is on the rise.

Findings suggest that it is already circulating widely in India, where the health system is much less likely to identify its presence or have adequate antibiotics to treat patients. Researchers identified 44 cases of NDM-1-positive bacteria in Chennai, and over 100 more in other cities in India, Pakistan, and Bangladesh.

In the United Kingdom, the gene has so far been identified in 37 people, all of whom underwent surgery in Southeast Asia. The bug has also been detected in Australia, Canada, the Netherlands, and Sweden. According to the U.S. Centers For Disease Control (CDC), the first three occurrences of the gene in the United States appeared in the first half of 2010, all in patients who had received recent medical care in India.

Not Widespread...Yet

Still, the numbers of people who have been identified with the gene remains very small. But the study's authors say that with the "medical tourism" industry booming, and call "the potential of NDM-1 to be a worldwide public health problem is great."

They also warn of the bug's "alarming potential to...diversify." To date, the gene has only been found attached to strains of pneumonia and E. coli, but with the ability to jump between bacteria, it could produce strengthened versions of a host of other infections.

"The resistance [could] spread along lots of different bacteria and the resistant bacteria [could] spread among lots of patients," Livermore said. "And then we would be in real trouble. It would be much harder to treat a broad range of infections."

To counter the spread of the bug, Livermore and his team recommend increased investment in research on new antibiotics and the establishment of a global surveillance system.

Anders Ekblom, the global head of medicines development at AstraZeneca, the pharmaceutical company that manufactures carbapenem, or "last resort" antibiotic, said the industry was already working on the underlying problem.

He said experts have "long recognized the growing need for new antibiotics." Ekblom also noted that "bacteria are continually developing resistance to our arsenal of antibiotics and NDM1 is just the latest example."

Prior to infecting a person, the bacteria can be stopped through normal infection-control measures, such as properly disinfecting hospital equipment and frequent hand-washing with antibacterial soap.

Alex Kallen, a medical officer at the CDC, said that while the gene may be a troubling new example of a superbug, the phenomenon is far from new.

"I think, you know, these [bacteria] are very serious and highly resistant organisms, and so they are a very important public health issue," Kallen said. "But this new mechanism [NDM-1] in and of itself, as far as we know, isn't anything that's different than what we are already seeing in the United States right now."

International organizations are stressing the need to prevent infection before it occurs through normal control measures, such as properly disinfecting hospital equipment and frequent hand washing with antibacterial soap.

written by Richard Solash based on RFE/RL and agency reports
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