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SUPER BUG

NDM-1

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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

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What is Superbug

Gene can be transferred between bacteria inhorizontal fashion by conjugation, transductionor transformation; thus a gene for antibiotic

resistance which had evolved via naturalselection may be shared.

Many antibiotic resistance gene resides onplasmids, facilitating their transfer.

If a bacterium carries several antibioticresistance genes it is called multiresistant orinformally a SUPERBUGorsuper bacteria

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Origin of AntibioticRsistance

The widespread use ofantibiotics both insideand outside ofmedicine is playing a

significant role in theemergence of resistantbacteria. (Super bug)

In India antibiotics that

are sold most oftenwithout prescriptioninclude Tetracycline,Amoxycillin, Ofloxacin

and Ciprofloxacin

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NDM-1 Gene

Is a type of Carbapenem resistancegene, designated as blaNDM-1. or also

designated as NDM-1 gene.

It is coded with ND Mettalo-beta-

lactamase enzyme (here ND stands forNew Delhi)

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NDM-1 symptoms

NDM-1 symptoms arereported to be associated withthe bacteria it attaches to.

The currently known bacteria's

hosting this gene are E.Coliand Klebsiella pneumoniae. The majority of the patients

treated to date who are positivefor NDM-1 were those with G.I.

tract infections, bacteraemia, orpneumonia

May cause multi-organ failureleading to death.

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NDM-1 genes can live inside

different bacteria and isresistant to currently availableantibiotics.

NDM-1 is the generesponsible for the newestsuperbug.

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New Delhi metallo-beta-lactamaseWhy 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 campaignto promote the development of new antibioticsby 2020.

The closest new antibiotic in development isstill at least 18 months awa from the market.

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Naming the gene as New Delhi createsControversy

The gene was named after New Delhi, the capitalcity of India, as it was first described by Yong etal. in 2008 in a Swedish national who fell ill withan 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 Klebsiellapneumoniaestrain, bearing the novel gene wasidentified.

The authors concluded that the new resistance

mechanism clearly arose in India.

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Blame on India is it justified ?

The US cases occurred this year in peoplefrom California, Massachusetts and Illinois

All 3 gave the history of travel &hospitalization to India prior to the illness.

India lacks policies on antibiotics andinfection control.

Also there no registered data availableregarding the hospital acquired infections.

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A joint study led by Chennai basedKarthikeyan Kumarasamy, at university of

Madras and UK based Timothy Walsh fromdepartment of immunity, infection andBiochemistry, department of Medicine, Cardiff

University researchers sought to examinewhether NDM-1 producing bacteria wasprevalent in south Asia and Britan

They found the superbug in 44 patients inChannai, and 26 in Haryana, besides 37 in theUK and 73 in other places across India,Pakistan and Bangaladesh.

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Comments from Health Ministry

It is unfortunate that the new

bug, which is anenvironmental thing, has

been attached to a particularcountry which is India in this

case.

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Various comments

ICMR:- said it is an attempt to hurtmedical tourism in the country that is

taking away huge customs fromhospitals in the west.

Such infections can flow in, from any

part of the world. It is unfair to say itoriginated from India. ICMR directorDr. V.M. Katoch

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Confederation of Indian Industry (CII)estimates

1.1 million foreigners travel to India each year forcheaper 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 thecost- 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 aear.

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Do we have options to treat ?

Treatment presentsmajor challenges.Most isolates with

NDM-1 enzyme areresistant to allstandard

intravenousantibiotics for

treatment of severe

infections

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CDC infection control guidance

CDC infection control guidance forcarbapenem-resistant Enterobacteriaceaealsois appropriate for NDM-1--producing isolates .

This includes recognizing carbapenem-resistant Enterobacteriaceaewhen culturedfrom clinical specimens, placing patientscolonized or infected with these isolates incontact precautions

and in some circumstances, conducting pointprevalence surveys or active-surveillance

testing among other high-risk patients.

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Surveillance helps effective careto prevent spread

The goal of active surveillance is to identifyundetected carriers of carbapenem-resistant orcarbapenemase-producing Klebseillaspp.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 measuresshould be vigorously reinforced, and surveillancecultures repeated periodically (e.g., weekly) until

no new cases are identified

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Phenotypic detection with Hodgetest a Minimal requirement

Carbapenem resistanceand carbapenemaseproduction conferred by

blaNDM-1 is detectedreliably with phenotypictesting methodscurrently recommended

by the Clinical andLaboratory StandardsInstitute , including diskdiffusion testing and the

modified Hodge test

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The spread of NDM-1 can becontained with ..

The spread ofNDM-1 withinhealth-care facilitiescan be curbedthrough strictinfection-controlmeasures, includingpatient isolation andhand washing.

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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/62

95662 www.stltoday.com/lifestyles/health-med-

fit/fitness/article www.en.wikipedia.org/wiki/super_bug_(bacteria) Loss Anglis

Times,collectio,bacteria,september21,2010 The Sunday Express, August 29,2010;p9

http://www.thelancet.com/infectionhttp://www.hindustantimes.com/storypage/585442http://www.ibnlive.in.com/http://www.timesofindia.indiatimes.com/articleshow/6295662http://www.timesofindia.indiatimes.com/articleshow/6295662http://www.stltoday.com/lifestyles/health-med-fit/fitness/articlehttp://www.stltoday.com/lifestyles/health-med-fit/fitness/articlehttp://www.en.wikipedia.org/wiki/super_bug_(bacteria)http://www.en.wikipedia.org/wiki/super_bug_(bacteria)http://www.stltoday.com/lifestyles/health-med-fit/fitness/articlehttp://www.stltoday.com/lifestyles/health-med-fit/fitness/articlehttp://www.stltoday.com/lifestyles/health-med-fit/fitness/articlehttp://www.stltoday.com/lifestyles/health-med-fit/fitness/articlehttp://www.stltoday.com/lifestyles/health-med-fit/fitness/articlehttp://www.timesofindia.indiatimes.com/articleshow/6295662http://www.timesofindia.indiatimes.com/articleshow/6295662http://www.ibnlive.in.com/http://www.hindustantimes.com/storypage/585442http://www.thelancet.com/infection

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Thank You