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Superbug may originate from India - study

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Superbug found in the United Kingdom may come from India through some patients who sought to receive some cosmetic or plastic surgery in the Asian country, British scientists suggest in a study published in the journal The Lancet.

The superbug with an enzyme known as NDM-1 short for New Delhi metallo-beta-lactamase, which confers drug resistance to all antibiotics including the most recently developed antiobitic named Carbapenem, is more dangerous than MRSA -Methicillin-resistant Staphylococcus aureus, which is resistant to some antibiotics.

The researchers said UK patients infected with the superbug with the NDM-1 gene got the pathogen from India.

Indian lawmakers reportedly complained that the infection of this superbug can occur anywhere in the world saying that it is a conspiracy that UK scientists' suggest that the superbug originates in India. They pointed out the UK study was sponsored by drug companies and there was conflict of interest.

They said this allegation created a unfair scare that could potentially damage the country's medical tourism business. India is one of most popular destinations for medical tourism.  Many people go to the country to receive plastic surgery.

In addition to India, Pakistan, and the UK, United States has also reported cases of NDM-1 in some states.

Last year, the Centers for Disease control and Prevention issued a guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in the March 20, 2009 issue of Morbidity and Mortality Weekly Report (MMWR).

In the report, editors say that the gene which is responsible for a carbapenemase enzyme, that is, beta-lactamase, but unidentified at the time, is a mobile gene or transposon, which can jump from one microorganism to another, increasing the risk of dissemination.

The enzyme has been found in 24 states ever since first described in North Carolina in 1999.  It is now recovered routinely in some hospitals in the New York and New Jersey, the CDC says in its MMMR report. The gene was found in 8 percent of all Klebsiella pneumoniae isolates.

In 2008, one outbreak resulting in 39 cases of carbapenem-resistant Klebsiella pneumoniae  occurred in a hospital in Puerto Rico. 

Carbapenems including imipenem and meropenem, are the most potent β-lactam  antibiotics indicated to fight drug resistant gram-negative bacteria.  There are fewer antibiotics for treating gram-negative bacteria compared to drugs for treating gram-positive bacteria like MRSA, according to New York Times.

Carbapenem-resistant Klebsiella pneumoniae is more commonly seen than carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in the United States, according to the CDC report.

The CDC recommends that all acute facilities should implement contact precautions for patients colonized or infected with Carbapenem-resistant Klebsiella pneumoniae or carbapenemase-producing Enterobacteriaceae. But no recommendation is made as to when to discontinue contact precautions.

On June 25, 2010, the CDC reported in a June 25 MMWR that three  Enterobacteriaceae isolates carrying a newly described resistance mechanism, the New Delhi metallo-beta-lactamase (NDM-1), were identified from three U.S. states at the CDC antimicrobial susceptibility laboratory.

These isolates including an Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae carried blaNDM-1, which confers drug or antibiotic resistance.

The CDC cited one early report as saying the superbug Enterobacteriaceae containing NDM-1 found in UK patients was associated with medical care from India and Pakistan.  And the three U.S. isolates came from patients who actually received medical care in India.

This report says that once a superbug is identified, the isolate should be sent to the CDC within 6 months for further characterization and infection control interventions should be implemented to prevent transmission of the pathogen.

By Jimmy Downs

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