Emergence of a New Antibiotic Resistant Organism

Tourist seeking treatment in India, Pakistan, and the UK are bringing home a dangerous type of bacterial infection that is resistant to nearly all antibiotics, according to an article released today in The Lancet (www.lancet.com).  Doctors have identified 29 patients in the United Kingdom (UK) with this new resistant bacteria.  Most of the individuals have traveled to India, Pakistan or Bangladesh for medical procedures, which included cosmetic surgery.  Dozens of patients from Asia have also gotten infected according to the researchers from Cardiff University.  Most of the new infections involved two common bacteria, E. coli or Klebsiella pneumoniae.  In these cases the bacteria aquired a gene that made it resistant to all but one or two known antibiotics.  The gene is named NDM-1 which protects the bacteria by producing an enzyme that destroys the antibiotics.  NDM-1 was first identified last year but researchers have found some cases dating back to 2003.

NDM-1 is resistant to antibiotics that medical professional consider a “last resort” drug against resistance, they are susceptible to colistin, and tigecycline.  Colistin has not been used much since the 1970s because of toxic side effects.  The new strains appear to be widespread in many medical centers in south Asia and have been seen in Canada, Australia, the Netherlands, Sweden and the United States.  CDC identified three cases in June among patients who were infected with bacteria carrying the NDM-1 gene.  All of the infected patients had undergone surgery in India.

The CDC alerted doctors to the possibility of resistant infections in any patient who had received medical treatment in Pakistan or India.  The CDC also recommended that if patients were identified they should be isolated and physicians and nurses should take extra precautions and wear personal protective equipment including fluid resistant gowns and gloves in combination with Standard Precautions.

Although there are only a few cases identified the fact that the new gene is found in different kinds of bacteria is very troubling.  This gives the NDM-1 gene the potential to spread more quickly and more widely than if it were found in only one bacteria.

Researchers have identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan.

The potential of New Delhi Metallo-ß-lactamase 1 (NDM-1) to be a worldwide public health problem is great, and international surveillance is needed.