Ready to test for the new super-superbug?

Nov. 1, 2010

J apan recently confirmed its first case of a new gene in bacteria that allows the microorganisms to become “superbugs” — resistant to nearly all known antibiotics. MLO cited the NDM-1 gene (October 2010, p. 6) as a new twist on an already serious business. This gene has been seen mostly in deadly Escherichia coli and on DNA structures easily copied and passed to other bacteria types.

While drug-resistant bacteria are not new, August's Lancet cites NDM-1's potential as a worldwide health problem begging for coordinated international surveillance. The World Health Organization (WHO) worries, since antimicrobial resistance already portends an increasing global threat affecting control of respiratory infections and dysentery.

The “super-superbug” has been detected in Australia, Canada, the Netherlands, Sweden, and the U.S. and U.K. The Japanese NDM-1 patient sought unnamed medical treatment in India where NDM-1 circulates widely.

Because many Americans and Europeans travel to India and Pakistan for affordable elective cosmetic procedures prompts researchers to suspect it is likely the superbug gene will spread worldwide.

Aside from its contributions in the field of cosmetic surgery, India — the world's largest manufacturer of generic drugs — is the go-to venue for counterfeit and substandard medicines. Experts on India's $90-billion “fake-drug” industry estimate it causes almost 1 million deaths annually and contributes to the rise in drug resistance.

Countries have successfully battled multidrug-resistant (MDR) microorganisms before. The WHO recommends governments focus efforts on NDM-1 surveillance, rational antibiotic use, legislation to stop sales of antibiotics without prescription, and rigorous infection-prevention measures.

An Australian hospital instituted daily facility-wide wash-downs with high-strength bleach, completely eliminating VRE bacteremia in the ICU, transplant units, and other high-risk wards.
French hospitals now screen for NDM-1 in patients transferred from foreign hospitals; a National Institute of Health and Medical Research professor/advisor to France's health ministry says a test for the NDM-1 germ has already been developed by his colleagues.

The recent Interscience Conference on Antimicrobial Agents and Chemotherapy report claims perianal swabbing failed to detect colonization of MDR Gram-negative bacteria in 21% of previously tested patients. The swab analyzed 35 patients for E coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae, Proteus mirabilis, and Morganella morganii; these patients previously tested positive for MDR Gram-negative bacteria in clinical cultures.

One medical doctor involved told MedPage Today, “Our data may underestimate the colonization of patients with these bad bugs.” The study's researcher suggests future studies may compare data against a full-rectal swab or stool culture, or use more limited scope analysis that provides higher accuracy (e.g., K pneumoniae PCR tests).

Whether hand-washing, using prescription-only antibiotics, testing incoming hospital patients coming from the hinterlands, and scrubbing an entire hospital's innards with bleach become part of current practices, keeping abreast of a bacteria-jumping gene that could easily land in our midst without warning is now more urgent than ever.

And, aside from worrying about the next big “bug,” my thoughts for this season are that you each enjoy a pleasurable Thanksgiving with your friends and families.