Case of NDM-1 superbug appears to be first acquired within Canada: researchers

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Case of NDM-1 superbug appears to be first acquired within Canada: researchers

By Sheryl Ubelacker, Health Reporter, The Canadian Press | The Canadian Press –

17 hours ago

TORONTO - Canadian researchers have identified what appears to be the first

domestically acquired case of an NDM-1 superbug.

An 86-year-old Ontario man was found to be carrying bacteria resistant to most

antibiotics because of NDM-1, or New Delhi metallo-1, an enzyme that alters the

DNA of various types of bacteria. NDM-1 is endemic in India and Pakistan and has

spread worldwide due to global travel.

But the patient, who was admitted to hospital and then a rehabilitation centre

after suffering a stroke last October, had not travelled outside southwestern

Ontario for the last decade. None of the man's family members or other close

contacts were carrying the superbug, nor had any been to parts of the world

where NDM-1 is widespread.

" So it's really unfortunately a mystery in terms of his source, and it certainly

suggests that he acquired it here in the southwestern Ontario region, " said Dr.

Poutanen, an infectious disease physician at Mount Sinai Hospital in

Toronto.

" So whether it was in Toronto, whether it was outside of Toronto, whether it was

in hospital or whether it was in the community, at this point we really can't

say, " added Poutanen, principal investigator of a study describing the case.

She said the case is not cause for public alarm but is meant to alert hospitals

and laboratories not to dismiss NDM-1 as a cause of drug-resistant bacteria in

patients merely because they have not travelled outside Canada.

So far, 28 cases of NDM-1-related cases have been reported across the country, a

spokeswoman for the Public Health Agency of Canada said Monday. All but the

86-year-old's case have been traced to travel in India or Pakistan.

At least two of those patients died, although not directly from the superbugs

they harboured. NDM-1 has primarily been found in E. coli and Klebsiella

bacteria, which are common causes of urinary-tract infections and pneumonia.

The Ontario man, who was colonized with an NDM-1 superbug but exhibited no

symptoms of infection, was not treated with the one antibiotic to which the

bacteria was susceptible to avoid the organism from developing even further drug

resistance.

The bacteria — ella morganii, a cause of urinary tract and other

infections — did not make the patient sick, but his intestinal system has

remained colonized with the altered microbe and close family members are being

regularly screened in case of possible transmission.

For privacy reasons, the hospital and rehab centre where the man was treated for

his stroke are not being disclosed, but testing showed he had not spread the

superbug to others, said Poutanen. " They screened every patient on the wards

where he had been; no one was carrying the NDM-1-containing organism. "

In a report on the case published Monday in the Canadian Medical Association

Journal, Poutanen and colleagues also describe another patient found to be

colonized with a different type of bacteria, also rendered multidrug-resistant

by NDM-1.

Last September, the 71-year-old woman was seen at a Toronto hospital after

returning from India, where she had travelled to obtain an MS-related medical

procedure not available in Canada. Doctors chose not to treat the women with

either of the only two antibiotics to which the bacteria remained susceptible,

again because the organism was not causing any symptoms.

Poutanen said that while there is no threat to the community at large,

infectious disease experts want to keep on top of NDM-1 to make sure it doesn't

take hold as it has in some countries.

" The reason why we're at all even looking at it is simply if somebody does

become infected, it really is a challenge because there are so few treatment

options, " she said. " So we want to try to avoid people getting infected, which

means we'd like to avoid persons becoming colonized and the spread of this bug. "

Dr. , director of the school of population and public health at the

University of British Columbia, agreed there is no need for public alarm.

" Secondary transmission after importation is possible, but it's important for

all of us to remember that sporadic transmission doesn't necessarily mean a

pattern that's going to spread throughout the population, " said , who was

not involved in the research.

" The main thing we need to understand is if the overall pattern of resistance in

our environment and in human beings is changing significantly in Canada — and I

don't see that this study has shown that. "

Still, suggests it would be prudent to keep tabs on close contacts of

travellers who return to Canada carrying an NDM-1 superbug to see if

transmission does occur and how often.

" And if we're not seeing it in the families and close contacts, from the people

who they share food and toilets with, then it's not going to be a risk to the

general community. "

Poutanen said the thrust of the CMAJ report is primarily to alert infectious

disease specialists across the country about the occurrence of the home-grown

case.

" We do want to make sure that laboratories and hospitals are ready, one, for

identifying it in the lab and, two, acting upon it from an infection-control

point of view to make sure we stay above this and that we don't let it become

endemic in our regions — and that we keep it at bay as much and as long as

possible. "

The study authors want to encourage hospitals to follow Public Health Agency of

Canada guidelines on infection control and to lab-verify any test results

showing antibiotic-resistant organisms from patients, even when they have not

travelled to NDM-1-endemic countries.

Poutanen said she and her colleagues would like public-health authorities to

make all NDM-1 cases reportable, so that any spikes in incidence can be spotted

and steps taken to contain possible transmission. Other superbugs — such as

methicillin-resistant staphylococcus aureus, or MRSA — are reportable diseases.

" The whole idea of keeping ahead of the game is to avoid that worst-case

scenario where we're seeing this more endemic and transmission in hospitals as

we're seeing with MRSA and the like. We don't want to see that. "