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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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Subscribe to comments feed Comments (14 posted):

BobbyMcBobberton on 08/13/2010 15:01:10
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Oh NO!!! NOT IMIPENEM AND MEROPENEM!!! Those are the two worst penems there are! And we all know that ?-lactam antibiotics are frammed up the rammastam when it comes to gram-negative bacteria.

I used to farm Carbapenem-resistant Klebsiella pneumoniae back before the 3rd reconcilliation of the pataris alkabeedis supplication in '77. This is OBVIOUSLY more commonly seen than carbapenem-resistant or carbapenemase-producing Enterobacteriaceae. DUH! You didn't need the CDC to tell us THAT!!!

For real. Who the hell was this article written for? And do you think anyone might be interested to know WHAT THE FRECK THE BUG *DOES*!?? Bleeding out the orifaces? Whooping cough!?

Holy god, you suck as a writer. Somebody fire this guy. What a waste of internet.
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g on 08/13/2010 15:18:07
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I have to agree. After reading this, I don't know if I should be scared or what it will do.

Perhaps it just eats the botox from the plastic surgery?
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Ken Hovanes on 08/13/2010 15:29:24
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There is a enzyme called NDM-1 which is easily transferred between bacteria (infections). The single most dangerous trait of this enzyme is that it dramatically increases antibiotic resistance in bacteria which have adopted the gene.

So... it means... it's not a SPECIFIC infection they are concerned about, it's related to ALL infections. An infection, like say, TB... if it were to acquire the resistance characteristics from the NDM-1 enzyme, that would be very bad, as it would be resistant to virtually every antibiotic currently available.
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Terrence Hohnhorst on 08/13/2010 15:35:10
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If they can wait six months to send in for
further tests how bad can this be. From a
lay person scientist / non medical.
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NM on 08/13/2010 15:40:30
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This is very important because if it does spread amongst bacterial organisms, it basically makes all of our scientific achievements completely worthless in terms of being able to fight infection.

Imipenem/Cilastin and Merrem are both very expensive drugs which were produced to help solve the relative shortage of gram-negative-effective bacteriostatics/anti-bacterials.

Anyone who scoffs at this news is ignorant, and I highly encourage you to learn more. This is very bad news. Very bad.
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Ed Hoarse on 08/13/2010 16:16:40
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Guess we will just have to go back to sulfur drugs, honey, nano silver, leeches and chicken soup.
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George Meredith MD on 08/13/2010 16:55:31
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The CDC rarely points out that MSRA and, now, NDM-1, infections almost always are related to some (foreign body) implant. Silastic being one of the worst!

Basic surgical principals. Irrigate wound at end of operation with strong penicillin solution. If infection occurs, usually on the third postoperative day, then, open wound widely. Change plain one inch Nuguaze Packing daily Don't rely on some super antibiotic. Get back to basics!

Search: George Meredith MD Comments for more information.

High dose IV Aqueus Penicillin was the drug of choice before the FDA removed it from the marketplace.

Those phony little C&S discs, Dr Fauuci, give completely different sensitivity results when the conentration of penicillin is increased ten fold, stupid!

"The best government is the least government."

George Meredith MD
Virginia Beach
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Philip V. on 08/13/2010 17:08:41
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Great letter, Bobbie. I remember the 3rd Reconcilliation back in '77. It was a nightmare.
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Andrew on 08/13/2010 17:21:18
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Thank you Dr. for adding the information about this usually being related to some type of foreign body implant. Any informaion helps. I also agree with teh previous commnets; this article really needs to be written for teh masses, in simple terms so the majority can understand. This is a very important subject and people need to understand the implications.
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Charlie on 08/13/2010 18:01:59
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I think perhaps some scientist are jumping the gun to early. It is important and many diseases to exist or originate in other countries, however perhaps they should show the actual statistics (numbers) of how many versus, how many have not contacted the disease, versus how many total surgical procedures have been done.


Charlie
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paul cohem on 08/13/2010 18:43:54
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Funded by Weith and European union, the same guys behind the global warming hoax..

ohhh india is all monkeys and snakes..India has the worlds most advanced healthcare at 1/20 of cost of a western country.

This is to kill medical tourism to india.
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Dr Edo McGowan on 08/16/2010 15:28:34
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Sewer plants are an excellent environment for gene exchange between bacteria. In sewer plants, pathogens which in nature might rarely get together are thrust into each other, thus greatly enhancing genetic exchange. Thus sewer plants and their byproducts are a principal route for the spread of antibiotic resistance and newly emerging infectious diseases. There have been some good studies coming out of India and elsewhere on the augmentation and generation of sewage assisted superbugs derived from hospitals, see: (http://www.indmedica.***/journals.php?journalid=6&issueid=21&articleid=179&action=article).

This tie to sewer plants is also well described by the Michigan study (http://www.ur.umich.edu/0809/May18_09/19.php). The US/EPA has known about this since the later 1970s or early 1980s but has been moribund to deal with it. It conducted a major study demonstrating gene transfer and release and then removed the results from its data base, one might ask why?----, see:(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC241834/pdf/aem00183-0119.pdf).

What we are finding is that the regulatory community, including the US/EPA and the US CDC have been asleep at the switch when it comes to how superbugs are made and then multiplied in sewer plants, thence spread through sewage byproducts such as biosolids into the environment and community. In discussing this with CDC, it indicated that there was no focused effort in this area. This is also curious since CDC indicates that antibiotic resistance is now a crisis. This is also reflected by WHO which considers the issue to be a global crisis. Consequently it will be important to see why the principal regulatory agencies have so ignored the issue of sewage and wastewater in the augmentation of antibiotic resistance.

Several U.S. scientists as well as scientists around the world have documented the spread of antibiotic resistance via treated sewage, biosolids or released treated wastewater. For example, see: “Vancomycin resistant enterococci (VRE) in Swedish sewage sludge” by Leena Sahlström, Verena Rehbinder, Ann Albihn, Anna Aspan, and Björn Bengtsson. Acta Veterinaria Scandinavica 2009, 51:24 doi:10.1186/1751-0147-51-24.

Documentation of antibiotic resistance and illness spread by sewage and its byproducts goes back decades but the regulatory community continued to ignore it----or worse, in cases actually hid it. The standards used are antiquated and the regulators are well aware of this also. Thus, along the great rivers in the U.S. and other nations, each successive city gets its drinking water from the immediate up-stream sewage outfall of the preceding city. Agricultural lands with applied biosolids also drain into these rivers carrying antibiotic resistant pathogens, see: “Increased frequency of drug-resistant bacteria and fecal coliforms in an Indiana Creek adjacent to farmland amended with treated sludge” by Shivi Selvaratnam and J. David Kunberger.

These processes cycle these bugs and each time they get stronger. The fact that we are now finding pharmaceuticals in drinking water shows one that the wastewater systems are not working. Unbeknown to most, there are antibiotic resistant genes, so small that they pass through most water treatment plants and are in fact now found in drinking water. These are not affected by chlorine at currently used levels. They easily transit within the human gut to the gut bacteria and there wait like tiny time bombs for an incoming pathogen, thus arming such pathogens with yet more resistance and virulence.

Once in the gut biota this damaging genetic information can remain for years and also because of the very large number of bacteria in the normal gut biota, there are opportunities for creating higher level pathogens. Antibiotic resistant infections in the United States now cause more deaths than AIDS. This is not an easy issue for U.S. regulators to accept, especially if they want you to believe all is well and rosy. But unless we want to return to amputation as the cure for infections, the regulatory community around the globe needs to wake up.

We may delay what Professor Timothy Walsh indicates as a lost battle by immediately dealing with the current standards for wastewater and redesigning sewer plants. There are extant systems and designs that greatly diminish the flow-through of pathogens. These designs remove the solids ahead of digestion. Digestion is where much of the gene transfer takes place. By removing the solids up front, many of the current liabilities are destroyed if the solids are converted to a biofuel. Additionally, the current use of sewage sludge on agricultural land merely spreads more antibiotic resistance into farming areas, thence into the food supply. The current use of reclaimed water on food crops does the same. The problem, in the main, lies in design standards and the operational standards. We have created this problem. With the rates of genetic exchange in current sewer plants and then the release of these new pathogens, the problem will rapidly get out of hand. It may be that current surgeries will not be possible because of the risk of unstoppable infection and cure for infection may revert to amputation.

Dr Edo McGowan
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Jinnah University for Women on 09/24/2010 10:54:53
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Thanks for the post, its really containing the descent knowledge and I really like the blog
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Mushahid Hussain on 09/30/2010 07:07:23
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Very informative detail..thanks
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