What Is NDM-1?
Editor's ChoiceMain Category: MRSA / Drug Resistance
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 12 Aug 2010 - 8:00 PDT
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NDM-1, which stands for New Delhi metallo-beta-lactamase-1 is a gene (DNA code) carried by some bacteria. If a bacteria strain carries the NDM-1 gene it is resistant to nearly all antibiotics, including carbapenem antibiotics - also known as antibiotics of last resort.
Carbepenems are the most powerful antibiotics, used as a last resort for many bacterial infections, such as E. coli and Klebsiella. The NDM-1 gene makes the bacterium produce an enzyme which neutralizes the activity of carbepenem antibiotics.
A bacterium carrying the NDM-1 gene is the most powerful superbug around.
Put simply:
- NDM-1(New Delhi metallo-ß-lactamase-1) is the gene (the DNA code) found in some types of bacteria
- This gene makes the bacteria produce an enzyme called a carbapenemase - making carbepenem antibiotics ineffective (as well as virtually all other antibiotics).
- Carbepenem antibiotics are extremely powerful and used to fight highly resistant bacteria (when other antibiotics have not worked).
- There are no current antibiotics to combat NDM-1
- There is no research in the pipeline on drugs to combat NDM-1
- A bacterium with the NDM-1 DNA code has the potential to be resistant to all our current antibiotics, as well as new antibiotics which may come into the market in the near future.
UK doctors say they had only ever seen a few cases which are resistant to carbapenems - and these had not been able to transfer resistance to other bacteria. The fact that NDM-1 can easily transfer to different bacteria strains is very worrying, they say.
Currently (12 August 2010) we know that some strains of bacteria, such as E. coli and Klebsiella pneumoniae carry the NDM-1 gene.
The origin of NDM-1
The gene was discovered by Young and team and was named after New Delhi, the Indian capital. The gene is widespread in India and Pakistan, especially in hospitals.Europeans who have undergone hospitalization in the Indian subcontinent have brought NDM-1 back to Europe. A significant number of Europeans who brought the gene back to Europe had undergone cosmetic surgery in India/Pakistan because it is cheaper there.
How untreatable is this superbug?
So far, doctors in the UK have managed to fight these infections with a combination of several different medications. However, scientists have detected some bacterial strains that are resistant to ALL antibiotics.The only way to currently combat the spread of NDM-1 is through surveillance, prompt identification and isolation of infected patients, disinfecting hospital equipment, and thorough hand-hygiene procedures in hospitals. This is going to be a challenge and will require international cooperation.
NDM-1 is widespread in India and Pakistan, and it has reached Europe, the USA, Canada and Australia.
Alerts in the UK
The Health Protection Agency (HPA), UK has issued an alert to medical professionals. Below is part of the alert:Allowing patterns of human travel and migration, and the many UK residents who receive medical treatment in India, we believe that UK healthcare will be repeatedly challenged by imported producers. These organisms mostly are resistant to ALL antibiotics except polymyxins and, less consistently, tigecycline. The activity of obscure agents (fosfomycin, arbekacin and isepamicin) and novel compounds is under investigation, but none is readily available for therapy. In these circumstances it is vital to detect producers and to prevent their onward transmission.
Actions advised
- Be alert to the increase in carbapenemase-producing Enterobacteriaceae, and the growing importance of NDM -1 enzyme.
- Recognise exposure to healthcare systems in India and Pakistan as additional major risk factors for infection or colonization with multiresistant, carbapenemase-producing Enterobacteriaceae
- Refer ALL carbapenem-resistant Enterobacteriaceae to ARMRL, except (i) Proteus spp. and Morganella spp. With borderline resistance only to imipenem (common in these genera) and (ii) E. cloacae with intermediate resistance to ertapenem only, as these are generally just derepressed for AmpC. NDM production will be investigated promptly.
- Patients infected with producers should be isolated to prevent onward transmission in hospitals; carriage in the patient's faecal flora should be examined for producers of the same or different species; similar screening of close unit contacts should be strongly considered.
Written by Christian Nordqvist
Copyright: Medical News Today
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Visitor Opinions In Chronological Order (15)
Slae of antibiotics at OTC drugs in India
posted by Joseph Christie, Ph.D on 12 Aug 2010 at 9:43 amAbout 45 years ago, I was a leading pharmaceutical Company Salesman in India. I represented one of the finest Companies , Parke-Davis, now part of Pfizer, Inc. During the sixties you could buy, you name it, without prescription in an Indian drug store any Antibiotics ( narrow, medium and broad), any tranquilizer, barbiturates, anticonvulsant etc etc,.
Antibiotics like Chloromycetin, Erthythomycin etc etc, were indiscriminately used then, and shockingly this dangerous practice, just for MONEY, is going on even in 2010 in India. You could buy a whole range of modern antibiotics like without prescription and the so called Drug Inspectors would make the politicians blush with their bribery and extortion tactics. Finally, all these have come home to roost. Instead of a becoming a Super Power, India has unleashed its Super Bugs on the whole world !
Unfortunate Naming
posted by Sriram on 12 Aug 2010 at 12:08 pmConsidering that superbugs that have been first observed in Europe have not been named for example "London Diff" or "Paris Coli" (was mad cow disease ever called the British Bovine disease?), the naming of this enzyme does raise some concerns about the attitudes of the scientists involved. One does not question the science, but one cannot help but wonder if there no political, racist agendas behind this whole affair.
Unfortunate naming
posted by Carol Coad on 12 Aug 2010 at 4:22 pmSriram, this naming is not racist! It is simply where it came from. Lots of things are labelled this way OR named after the person who discovered them. C diff is so named because that is it's microbiological named which was mostly decided before anyone actually knew what it did. Mad cow disease is also found all over Europe and in the USA. In the scientific/medical world, we focus on the disease, the antibiotic, etc. In all of my 40years in Microbiology, this is the first suggestion of racisism in names. In my opinion, an unneccessary and unwarented accusation!
Unfortunate naming
posted by Mangentia on 12 Aug 2010 at 8:36 pmCarol, Sriram is right in saying that there was no need to name this such a way that it is associated to a capital of a country!! In your response, you are not answering Sriram's question on why other viruses/bacterias were not named to associate them to their origins, but only in this case scientists are taking a different route!!
Unfortunate Naming
posted by Rohit Jain on 12 Aug 2010 at 9:32 pmSriRam is right in saying why the Swine flu virus was not named as spain virus and why the HIV is not named as American Virus. Is this not harming the reputation of India in the whole world and is this not a direct attack on the Health tourism of India. This name is really not related to science but it is related to something else which most of the people knows.
Superbug Hype!!
posted by GODWIN WILSON on 13 Aug 2010 at 12:44 amDrug resistance has evolved from time immemorial. It has crossed states, countries and continents with increasing travel (may it be for medical tourism or otherwise).
What makes a micro organism a ‘Superbug’ is the genetic makeup of the bacteria. These are usually coded in packets (Plasmids) in the bacteria and are transmitted just like human transmission of genetic mutations. The decoding of these plasmids give insight into the character of the bacteria (how long it will live, how many drugs it is resistant to, how fast they can be transmitted etc) and is similar to gene mapping in humans which tells the character of humans (colour, cancer carriers, genetic disorders, height, how long we will live, will he be diabetic etc).
Most superbugs can generally be detected in routine standard microbiology labs eg. MRSA (Methicillin resistant Staphylococcus aureus, ESBL (Extended spectrum beta lactamase) in E coli, Klebsiella and others, MBL (metallobetalactamase etc). Research studies can detect special characters (genetic makeup) in such bugs (e.g. in MRSA mecA, in ESBL- CTX-M, IMP, in MBL BlalMP, VIM, NDM-1 etc ) . Routine laboratories anywhere in the world cannot detect such special characters.
Superbugs are rare but when it occurs it should trigger ANY government, state, health care facility to the following aspects:
1. Resistance evolves in bacteria due to abuse of antibiotics. (so probably hospital or community physicians are abusing drugs). Abuse of antibiotics occurs usually in the subcontinent and south east asian countries.
2. Some codes are transmitted by drug feeds in poultry or the food we eat, how close we are with animals can manufacture and these bugs (Again antibiotic abuse).
3. Regular isolation of the same organism from the same location (hospital, country) can result in outbreaks or epidemics). Outbreaks of this organism can occur if the organism is transmitted quickly usually due to poor infection control practices in the hospitals.
4. The hospital should be aware and report such types of bugs both in the interest of the patient and community as a whole.
5. Its not where these isolates come from but how their transmission can be prevented that is important. Sometimes where it comes from is important as incase of Bioterrorism agents (Anthrax etc)
6. If increasing Superbugs are seen in a locality they should be tested in research laboratories to know the genetic makeup.
So don’t blame countries. Be scientific not political.
Learn to develop research facilities that can detect such infections.
Look into all Hospital systems and Microbiology laboratories to see if facilities are in place to identify and isolate superbugs.
Finally report these to the international community and the interest of patient care as a whole.
Dr Godwin Wilson, Clinical Microbiologist
Et Tu LANCET!!!
posted by S.N.Balakrishnan on 14 Aug 2010 at 7:49 amIt is a pity that Lancet lent its name to UK HPA/NHS strategy to prevent Medical Tourism to India and Pakistan through naming the super bug as New Delhi M1. Research indicates it is prevalent in many countries including USA,Australia and Europe.When MRSA was discovered after studies for over 3 years and found in 300 hospitals in the US the researchers did not name it after USA because they were professionals trying to mitigate human misery. The fact that Dr.Livermore of UK HPA harps on the linkage to medical tourism clearly indicates the bias. We can only say Et tu Lancet!
How do you get this bacterial infection?
posted by adi on 14 Aug 2010 at 4:27 pmhello i have G6PD dificency and i just wanted to know how do u get this infection? is it by jus standing next to someone who already has it or if u get operated on or if your in the vicinty of someone who has it? also if you did get it how likely is someone like me, who cannot take majority of antibiotics, to get cured?
Reality Of Antibiotics In India In The Context Of The Superbug Naming
posted by Dr. S.N. (Jag) Jagannathan on 16 Aug 2010 at 5:37 amGood comment,SN Bala. May be, political and economic interests may have contributed to the naming, But the facts are: in India, many half-educated persons are self-prescribing semi-doctors who can get the antibiotics filled in pharmacies without a Doctor's prescription. Besides, abuse of antibiotics by prescription by Indian doctors has been rampant in India in the last many decades,especially after oral antibiotics were discovered and approved in the West. I hope India starts doing something about this besides being hypersensitive about the name the bug.
Jagannathan, Jag & Syamala
solve the problem
posted by Mr.Akemfua Fualefac on 19 Aug 2010 at 6:47 amI think the most important thing to do now is to look for a way which this famous gene can be manage in bacteria and be treated in infected persons, after this is done then the naming problem is to be handled because it is not proper to name such a harmful thing with respect to the town or country from where it was found first.
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