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Superbug Has Arrived in the US

The term 'Superbug' has been at the forefront of health news all summer and it appears it will continue to be a hot topic into autumn.   Referring to antibiotic resistant bacteria, which appears to have originated in India, New delhi metallo-beta-lactamase (NDM-1), scientists have warned of the potential of NDM-1 spreading worldwide.

"NDM-1 is a newly recognized mechanism of resistance that allows certain bacteria to become resistant to certain antibiotics," said Dr. Alexander J. Kallen, a medical epidemiologist and outbreak response coordinator with the U.S. Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion.

Three cases of NDM-1 infection have now been reported in the United States receiving treatment in hospitals in Massachusetts, Illinois and California. 

The patient treated in MA was an Indian citizen with cancer who had undergone surgery and chemotherapy in India before traveling to Boston.  The other two patients had also traveled to India and undergone medical procedures in hospitals while there. 

NDM-1 is a close genetic cousin of another bacterium that has been present in the US for many years.  The challenge in treating these germs is that both produce an enzyme making them resistant to a group of antibiotics called carbapenems, which include penicillin and ampicillin.

Dr. Alexander J. Kallen, Epidemiologist and outbreak response coordinator with the CDC said,  "Unfortunately, carbapenem resistance is not uncommon even in the United States.  We have our own homegrown version of NDM-1 that has been recognized for quite a few years."

Kallen adds, "Carbapenem-resistant bacteria (KPC) appear to be transmitted in the US in health-care facilities such as hospitals and nursing homes, and are typically spread from patient to patient from contaminated surfaces and hands."

While methicillin-resistant staphylococcus aureus (MRSA) and E. coli have received the most attention, the arrival of NDM-1 in the US highlights the increasing problem of drug-resistant bacteria causing outbreaks in hospitals, gyms and schools. 

Researchers from the University of Nottingham are currently working on developing a drug from the tissues of brains and nervous systems of cockroaches and locusts which have already been shown to kill 90% of E. coli and MRSA bacteria without harming human cells.

"This is just another example of these multidrug-resistant [germs] that we are going to have to come to grips with,’’ said Dr. Alfred DeMaria, top disease tracker for the Massachusetts Department of Public Health.

Of special concern among global health specialists is the emergence of NDM-1 in India where antibiotics are cheap and available over-the-counter causing misuse which further enables drug resistance.  NDM-1 thrives in germs that proliferate in the gut; poor sanitation enhances the spread of the drug resistant bacteria.

“There are certain factors in the Indian subcontinent that are going to make this spread quite widely,’’ said Timothy Walsh, Cardiff University scientist who helped discover the germ. “It’s very easy for us to forget in the Western world how desperate the conditions are in some of these countries.’’

NDM-1 has been found in Singapore Canada, Pakistan and some nations in Europe.  While deaths have occurred as a result of the bacteria, Kallen wasn't sure of the number.  He adds, "we don't know how dangerous NDM-1 will become, but some studies have found the death rate from KPC to be as high as 40%."

Of the two Singapore patients, one is a Singapore resident who had sought medical treatment in India, and the other a patient from Bangladesh who had come to Singapore for medical treatment.  Much like the US cases, both patients admitted to a Singapore hospital were immediately isolated from other patients and contact with visitors was limited.

Dr. Alfred DeMaria, top disease tracker for the Massachusetts Department of Public Health said, “This is just another example of these multidrug-resistant [germs] that we are going to have to come to grips with."

Dr. Marc Siegel, Infectious Diseases Expert, Associate Professor of Medicine, New York University, NYC  believes that "antibiotic-resistant bacteria are emerging because of lack of cleanliness and sterility in hospitals, too many antibiotics being prescribed and drug companies not developing new antibiotics because they aren't profitable."