New superbug that is antibiotic resistant found in 3 US states

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New drug-resistant superbugs found in 3 states

http://news./s/ap/20100913/ap_on_he_me/us_med_superbug_gene

By MARILYNN MARCHIONE, AP Medical Writer – Sept 13, 2010

BOSTON – An infectious-disease nightmare is unfolding: Bacteria that have been

made resistant to nearly all antibiotics by an alarming new gene have sickened

people in three states and are popping up all over the world, health officials

reported Monday.

The U.S. cases and two others in Canada all involve people who had recently

received medical care in India, where the problem is widespread. A British

medical journal revealed the risk last month in an article describing dozens of

cases in Britain in people who had gone to India for medical procedures.

How many deaths the gene may have caused is unknown; there is no central

tracking of such cases. So far, the gene has mostly been found in bacteria that

cause gut or urinary infections.

Scientists have long feared this — a very adaptable gene that hitches onto many

types of common germs and confers broad drug resistance, creating dangerous

" superbugs. "

" It's a great concern, " because drug resistance has been rising and few new

antibiotics are in development, said Dr. M. Grayson, director of

infectious diseases at the University of Melbourne in Australia. " It's just a

matter of time " until the gene spreads more widely person-to-person, he said.

Grayson heads an American Society for Microbiology conference in Boston, which

was buzzing with reports of the gene, called NDM-1 and named for New Delhi.

The U.S. cases occurred this year in people from California, Massachusetts and

Illinois, said Limbago, a lab chief at the Centers for Disease Control

and Prevention. Three types of bacteria were involved, and three different

mechanisms let the gene become part of them.

" We want physicians to look for it, " especially in patients who have traveled

recently to India or Pakistan, she said.

What can people do?

Don't add to the drug resistance problem, experts say. Don't pressure your

doctors for antibiotics if they say they aren't needed, use the ones you are

given properly, and try to avoid infections by washing your hands.

The gene is carried by bacteria that can spread hand-to-mouth, which makes good

hygiene very important.

It's also why health officials are so concerned about where the threat is coming

from, said Dr. Patrice Nordmann, a microbiology professor at South-Paris Medical

School. India is an overpopulated country that overuses antibiotics and has

widespread diarrheal disease and many people without clean water.

" The ingredients are there " for widespread transmission, he said. " It's going to

spread by plane all over the world. "

The U.S. patients were not related. The California woman needed hospital care

after being in a car accident in India. The Illinois man had pre-existing

medical problems and a urinary catheter, and is thought to have contracted an

infection with the gene while traveling in India. The case from Massachusetts

involved a woman from India who had surgery and chemotherapy for cancer there

and then traveled to the U.S.

Lab tests showed their germs were not killed by the types of drugs normally used

to treat drug-resistant infections, including " the last-resort class of

antibiotics that physicians go to, " Limbago said.

She did not know how the three patients were treated, but all survived.

Doctors have tried treating some of these cases with combinations of

antibiotics, hoping that will be more effective than individual ones are. Some

have resorted to using polymyxins — antibiotics used in the 1950s and '60s that

were unpopular because they can harm the kidneys.

The two Canadian cases were treated with a combination of antibiotics, said Dr.

Johann Pitout of the University of Calgary in Alberta, Canada. One case was in

Alberta, the other in British Columbia.

Both patients had medical emergencies while traveling in India. They developed

urinary infections that were discovered to have the resistance gene once they

returned home to Canada, Pitout said.

The CDC advises any hospitals that find such cases to put the patient in medical

isolation, check the patient's close contacts for possible infection, and look

for more infections in the hospital.

Any case " should raise an alarm, " Limbago said.

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