By JENNY HOPE
Last updated at 7:20 PM on 11th August 2010
- Gene makes bacteria resistant to almost all antibiotics
- Patients brought enzyme back from India and Pakistan
The NHS is on red alert to detect a 'superbug' resistant to the most powerful antibiotics which has been imported from India by health tourists.
There are fears that without vigilance a new gene that allows any bacteria to become a superbug could become widespread in NHS hospitals.
It has infected around 50 Britons so far, many of whom returned to the UK after undergoing surgery in India or Pakistan.
The Health Protection Agency (HPA) yest (wed) stepped up its warnings about the new gene called NDM-1, or New Delhi metallo-beta-lactamose after the place where it was first identified.
Dr David Livermore, director of antibiotic resistance monitoring at HPA, said resistance to one of the major groups of antibiotics, the carbapenems, is found throughout India.
'This is important because carbapenems were often the last 'good' antibiotics active against bacteria that already were more resistant to more standard drugs.
The spread of the enzyme that makes any bug 'super'
Rising levels of antibiotic resistance are a threat because there are few new drugs in the pipeline.
Infection experts are alarmed about the spread of multi-drug resistance facilitated by the gene NDM-1 that can easily jump from one strain of bacteria to another.
If it ends up in a bacterium which is already resistant to many other antibiotics then it could produce infections that are almost impossible to treat.
NDM-1-producing bacteria are resistant to many existing antibiotics including carbapenems - a class of drugs often reserved for emergency use and 'last resort' treatment.
So far two types of bacteria have been host to NDM-1 - the gut bug E.coli and another that can invade the lungs called Klebsiella pneumonia.
Both can lead to urinary tract infections and blood poisoning.
E.coli is among a group of 'gram-negative' bugs, and the proportion of antibiotic-resistant cases of E.coli infection has trebled since the turn of the century.
There are about 20,000 E.coli bloodstream infections each year in England, Wales and Northern Ireland, of which more than one in ten is resistant to antibiotics.
There are just two antibiotics in the pipeline against this group of infections.
This compares with several new medications for gram-positive infections like MRSA.
Figures suggest it costs between
£500 million to £1 billion to bring new drugs to market.
GSK, one of a handful of giant pharmaceutial firms actively investing in antibiotic research, said: 'New antibiotics that work in different ways to existing medicines are desperately needed to tackle the rising incidence of antibiotics resistance.'
'We have now also identified bacteria with this type of resistance - NDM - in around 50 patients in the UK.
'Most not all, had previously travelled to the Indian subcontinent and many had received hospital treatment there.
'International travel gives a great potential for spread of resistant bacteria between countries.
'Few antibiotics remain active against these bacteria.Their spread underscores the need for good infection control in hospitals both in the UK and overseas, and the need for new antibiotic development.'
The HPA flagged up the problem last year but renewed its warnings after a study in journal The Lancet Infectious Diseases tracked the emergence of the 'superbug' gene in different countries.
The researchers found NDM-1 is becoming more common in Bangladesh, India and Pakistan and is starting to be imported back to Britain in patients returning from these countries.
Several of the British NDM-1 positive patients had recently travelled to the Indian subcontinent for hospital treatment including cosmetic surgery.
Timothy Walsh, professor of medical microbiology and antimicrobial resistance at Cardiff University, who led the study, said it was a 'real concern'.
'Because of medical tourism and international travel in general, resistance to these types of bacteria has the potential to tavel around the world very, very quickly.'
He said there are few drugs in development that can potentially combat the threat.
The resistant gene has also been detected in Australia, Canada, the US, the Netherlands and Sweden.
The NDM-1 gene alters bacteria, making them resistant to nearly all known antibiotics.
It has been largely found 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.
The researchers said the superbug gene 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.
Christopher Thomas, professor of molecular genetics at the University of Birmingham who was not linked to the study, said 'We are potentially at the beginning of another wave of antibiotic resistance, though we still have the power to stop it.'
Prof Thomas said better surveillance and infection control procedures might halt the gene's spread.
Although patients in British hospitals are unlikely to encounter the superbug gene, they should remain vigilant about standard hygiene measures like properly washing their hands, he added.
superbug
'The spread of these multi-resistant bacteria merits very close monitoring' wrote Johann Pitout of the division of microbiology at the University of Calgary, Canada, in an accompanying Lancet commentary.
He 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' he added.
The Department of Health spokesman said 'We are working with the Health Protection Agency. The HPA alerted the NHS in January and July lst year to be vigilant about these bacteria and take appropriate action where necessary.
'Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to the HPA for testing.'
New Dehli-Metallo-1, seen under the microscope could be untreatable for as long 10 years while scientists devise the right kind of antibiotics
Trusts to miss targets due to financial pressure
Financial pressures could see a quarter of leading hospitals at risk of breaching key health targets.
Annual plans submitted to the NHS regulator show that more than 20 foundation trusts say they may be unable to meet standards for cancer services.
Eleven have raised concerns over meeting targets in fighting superbugs, while three mental health trusts have flagged concerns over care delivery. The alerts are highlighted in yearly plans submitted to the regulator Monitor.
Its chief executive Steve Bundred said the regulator was forcing increased discipline on foundation trusts to improve planning and minimise risks to services.
He said trusts were showing 'a welcome dose of realism'.
Read more: http://www.dailymail.co.uk/health/article-1302035/Unbeatable-NDM-1-enzyme-make-bacterial-diseases-superbugs.html#ixzz0wKVJWnFg
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