An antibiotic resistant gene has been identified in India and patients who traveled there for medical tourism are picking up the bug too. Does this really hint at a gloomy future for us?

When I read The Guardian article called “Are you ready for a world without antibiotics,” I got chills. I keep hearing this concern echoed.

When I was in San Francisco, I spoke with Kevin Judice, the CEO of Achaogen, about his company’s mission to discover new ways to treat drug-resistant pathogens. He warned me of these gram-negative resistant bacteria that might launch us into an era without antibiotics. But that’s also why his company is focused on developing drugs to combat multi-drug resistant gram negative bacteria and Methicillin-resistant Staphylococcus aureus, or MRSA.

Doctors and the government prepared for the fight against the gram-positive superbug MRSA and the outbreaks appear to be more controlled. Infection of MRSA in the hospital has dropped.

But Darwinian evolution is part of life — and bacteria will continue to evade the drug weapons we throw at it. The bacteria will find some way to survive.

Meet NDM-1 gene. Cardiff University professor Tim Walsh discovered the NDM-1 gene in Klebsiella pneumoniae and Escherichia coli bacteria. It was first identified in a Swedish patient who was infected after undergoing a procedure at an Indian hospital in 2009.

The bug has been found in the UK, US, Australia, and in a number of other countries. Some fear that it will spread throughout the world as medical tourism remains a popular and cheap alternative.

What’s worse, the mutation makes bacteria resistant to nearly all antibiotics — even the ones that are supposed to act as our last line of defense.

The Lancet reports the spread of the mutated gene from where it is common in India and Pakistan back to the UK. The researchers report the incidence of the gene mutation as follows:

They identified 44 (1.5%) NDM-1-positive bacteria in Chennai, 26 (8%) in Haryana, 37 in the UK, and 73 in other sites in Bangladesh, India, and Pakistan. NDM-1 was mostly found in E coli (36), the most common cause of community-associated urinary tract infections, and K pneumoniae (111).

The gene can hop from one strain of bacteria to another because it is found on plasmids in the bacterial nuclei. Its location on the plasmid makes the mutant gene pretty promiscuous. While the infection has been found in a small number of people, experts worry that it transfers between different types of bacteria, which makes it harder to contain.

The fact that it exists in gram-negative bacteria, limits the number of drugs in the pipeline that can treat it.

Drug-resistant bacteria like the NDM-1 mutation are typically a problem in hospitals. Not only do the patients have welcoming open wounds, their immune systems are weaker, and the antibiotics they are on kill off healthy bacteria and let the drug-resistant ones flourish.

The growing trend for medical tourism will enable this bug to spread throughout the world. We are seeing what some experts believe, is the tip of the iceberg, in our inability to treat infections.

It only took this mutant three years to rise from obscurity to infect up to 3 percent of the population in India and Pakistan. The gram-negative bacteria resides in the gut and the fact that only two drugs can treat this infection (if at all) has some experts worried about the potential public health risk.

“The rapid emergence of these multi-drug resistant NDM-1 producing bacteria and their potential worldwide spread could herald a period in which antibiotics become redundant and demands very close international monitoring and surveillance,” Walsh says in a statement.

The Guardian paints a dark picture of what the world would be like if antibiotics couldn’t kill infectious bacteria: Transplant surgery can’t be done without running the risk of infection from life-threatening bacteria, routine appendix operation becomes dangerous once again, pneumonia will return as big-time killer, gonorrhea will become resistant, and there’s really going to be no way to treat tuberculosis.

The best thing doctors can do is practice better hygiene and take extra precaution in the hospital. Unfortunately the NDM-1 doesn’t discriminate. It has been found in the Asian community, spread through contaminated water — and can be spread to other parts of the world through travel.

Like my colleague Andrew Nusca mentions, the Indian government is calling the study unscientific and anti-India.

Related on SmartPlanet:

• The fight for life against superbugs

Superbug found in British patients returning from treatment in Asia

Published 11 August 2010
http://www.homelandsecuritynewswire.com/superbug-found-british-patients-returning-treatment-asiahttp://www.homelandsecuritynewswire.com/superbug-found-british-patients-returning-treatment-asia

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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