Superbug found in British patients returning from treatment in Asia

Published 11 August 2010

An antibiotic-resistant superbug has been found in British patients traveling to Asia for cosmetic surgery, cancer treatment, and transplants and returning to Britain for further care; the bug was found attached to E.coli bacteria, but the enzyme can easily jump from one bacterium to another and experts fear it will start attaching itself to more dangerous diseases causing them to become resistant to antibiotics; in Many Asian countries health standards in many Asian countries are poor and regulations are weak, and antibiotics are available to buy without prescription; this is thought to have encouraged resistance to develop as many infections are exposed to the drugs without being properly killed

British scientists have found a superbug which is resistant to most antibiotics and are warning that it is widespread in India and could soon appear worldwide. The superbug has so far been identified in thirty-seven people who returned to the United Kingdom after undergoing surgery in India or Pakistan.

In an article published online today (Wednesday) in the journal Lancet Infectious Diseases, doctors reported finding a new gene, called New Delhi-Metallo-1 (NDM-1). The gene alters bacteria, allowing them to become resistant to nearly all known antibiotics. It has been seen largely in E. coli bacteria, the most common cause of urinary tract infections, and on DNA structures that can be easily copied and passed onto other types of bacteria.

AP reports that the researchers said the superbug appeared to be already circulating widely in India, where the health system is much less likely to identify its presence or have adequate antibiotics to treat patients. Johann Pitout of the division of microbiology at the University of Calgary, Canada, wrote in an accompanying commentary

The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed,” the authors wrote.

Aside from the U.K., the resistant gene has also been detected in Australia, Canada, the Netherlands, the U.S. and Sweden. The researchers said that since many Americans and Europeans travel to India and Pakistan for elective procedures like cosmetic surgery, it was likely the superbug would spread worldwide.

The spread of these multi-resistant bacteria merits very close monitoring.

Pitout called for international surveillance of the bacteria, particularly in countries that actively promote medical tourism. “The consequences will be serious if family doctors have to treat infections caused by these multi-resistant bacteria on a daily basis.”

The Telegraph’s Rebecca Smith writes that the NDM-1 has been found in patients traveling to Asia for cosmetic surgery, cancer treatment, and transplants and returning to Britain for further care. The bug was found attached to E.coli bacteria, but the enzyme can easily jump from one bacterium to another and experts fear it will start attaching itself to more dangerous diseases causing them to become resistant to antibiotics.

The bug is even resistant to the class of antibiotics known as Carbapenems which are reserved for use when all other antibiotics have failed.

Already last year, the Daily Telegraph highlighted how the bug had then been found in twenty-two patients in Britain and government scientists had issued an alert to hospitals to test for it and limit its spread.

Members of the international team which wrote today’s Lancet article have tracked NDM-1 in India, Pakistan, Bangladesh, and Britain and found the disease is more widespread than previously thought.

Co-authors of the research, Professor Timothy Walsh from Cardiff University and Professor David Livermore from the Health Protection Agency, wrote in the paper: “The NDM-1 problem is likely to get substantially worse in the foreseeable future…. The potential for wider international spread and for NDM-1 to become endemic worldwide, are clear and frightening.”

Antibiotics are available to buy without prescription in many countries in Asia and this is thought to have encouraged resistance to develop as many infections are exposed to the drugs without being properly killed.

The team found NDM-1 carried by young women with urinary tract infections but not other illness and in patient who are vulnerable after having kidney transplants and cancer treatment. A victim of a road traffic accident in India developed an infection with NDM-1 in the bones of his fractured foot and another was infected in their wound after a ‘tummy tuck’ operation.

Professor Livermore said: “These are not bacteria that are historically very harmful to humans but medicine has got better at keeping people alive with conditions that would normally have killed them and they can be exploited by these bacteria. The risk is that you have an enzyme with very major resistant and if it combined with a particularly nasty bacterium, then that would be a concern.”

—Read more in Karthikeyan K Kumarasamy et al., “Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the U.K.: a molecular, biological, and epidemiological study,” Lancet Infectious Diseases, Early Online Publication (11 August 2010) (doi:10.1016/S1473-3099(10)70143-2)

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