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0 August 2010 Last updated at 20:06 ET
New 'superbug' found in UK hospitals
By Michelle Roberts Health reporter, BBC News
NDM-1 has been found in E.coli bacteria
A new superbug that is resistant to even the most powerful antibiotics has entered UK hospitals, experts warn.
They say bacteria which make an enzyme called NDM-1 travelled back with NHS patients who had gone abroad to countries like India and Pakistan for treatments such as cosmetic surgery.
Although there have only been about 50 cases identified in the UK so far, scientists fear it will go global.
Tight surveillance and new drugs are needed says Lancet Infectious Diseases.
NDM-1 can exist inside different bacteria, like E.coli, and it makes them resistant to one of the most powerful groups of antibiotics - carbapenems.
These are generally reserved for use in emergencies and to combat hard-to-treat infections caused by other multi-resistant bacteria.
Continue reading the main story “Start Quote
And experts fear NDM-1 could now jump to other strains of bacteria that are already resistant to many other antibiotics.
Ultimately, this could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.
At least one of the NDM-1 infections the researchers analysed was resistant to all known antibiotics.
Similar infections have been seen in the US, Canada, Australia and the Netherlands and international researchers say that NDM-1 could become a major global health problem.
Infections have already been passed from patient to patient in UK hospitals.
The way to stop NDM-1, say researchers, is to rapidly identify and isolate any hospital patients who are infected.
Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.
And currently, most of the bacteria carrying NDM-1 have been treatable using a combination of different antibiotics.
But the potential of NDM-1 to become endemic worldwide is "clear and frightening", say the researchers in their Lancet paper.
National alert Dr David Livermore, one of the researchers and who works for the UK's Health Protection Agency (HPA), said: "There have been a number of small clusters within the UK, but far and away the greater number of cases appear to be associated with travel and hospital treatment in the Indian subcontinent.
E. coli can cause urinary tract infections and blood poisoning
"This type of resistance has become quite widespread there.
"The fear would be that it gets into a strain of bacteria that is very good at being transmitted between patients."
He said the threat was a serious global public health problem as there are few suitable new antibiotics in development and none that are effective against NDM-1.
The Department of Health has already put out an alert on the issue, he said.
"We issue these alerts very sparingly when we see new and disturbing resistance."
Travel history The National Resistance Alert came in 2009 after the HPA noted an increasing number of cases - some fatal - emerging in the UK.
The Lancet study looked back at some of the NDM-1 cases referred to the HPA up to 2009 from hospitals scattered across the UK.
At least 17 of the 37 patients they studied had a history of travelling to India or Pakistan within the past year, and 14 of them had been admitted to a hospital in these countries - many for cosmetic surgery.
For some of the patients the infection was mild, while others were seriously ill, and some with blood poisoning.
A Department of Health spokeswoman said: "We are working with the HPA on this issue.
"Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.
"So far there has only been a small number of cases in UK hospital patients. The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues."
10 August 2010 Last updated at 22:24 ET
Q&A: NDM-1 superbugs
By Michelle Roberts Health reporter, BBC News
NDM-1 is carried by gram-negative bacteria like Klebsiella
Experts have warned that a new type of drug-resistant superbug is emerging in UK hospitals.
Q: What is NDM-1?
New Delhi metallo-ß-lactamase-1, or NDM-1 for short, is an enzyme that can live inside different bacteria. Any bacteria that carry it will be resistant to carbapenem antibiotics. This is concerning because these antibiotics are some of the most powerful ones, used on hard-to-treat infections that evade other drugs.
Q: Why is this a problem?
NDM-1 (or more precisely the DNA code for this enzyme) can easily now jump from one strain of bacteria to another.
Experts are worried that it may end up in another bacterium which is already resistant to many other antibiotics.
Ultimately, it could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.
Q: Can it be treated?
Other treatment options are available to fight these infections but they present major challenges for clinicians and will often demand combinations of antibiotics are used.
Scientists have identified some strains that have been resistant to all known antibiotics.
Q: How would I know if I had it?
So far, many of the UK cases have been in patients who have recently travelled to India or Pakistan for medical treatment and who caught the infection while there.
But, some of these patients have passed the infection on to others in UK hospitals upon their return.
The infections have ranged from mild to severe - and some have been fatal.
Two types of bacteria have been host to NDM-1: the gut bacterium E.coli and another that can invade the lungs called Klebsiella pneumonia. Both can lead to urinary tract infections and blood poisoning.
Infections such as these would usually be spotted in patients by medics.
Q: Can its spread be stopped?
Experts say the way to stop it is through surveillance, rapid identification and isolation of any hospital patients who are infected.
Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.
NDM-1 is already widespread in the Indian subcontinent and has also reached countries including the US, Canada, Australia and the Netherlands. Scientists believe it has the potential to become a global public health issue.
And they say we now need new drugs to treat resistant strains.
Q: Are there new antibiotics that could help?
While there is a great deal of investment in research to find new antibiotics, experts say that most of the drugs currently in the pipeline will be useless for treating NDM-1 positive patients.
This is because the bacteria that carry NDM-1 are gram-negative, while most of the work is being carried out for gram-positive bugs like MRSA.
The Health Protection Agency says "multi-resistant gram-negative bacteria pose a notable public health risk and it remains important that the pharmaceutical industry continues to work towards developing new treatment options".
The Department of Health said it was investigating ways of encouraging the development of new antibiotics with European colleagues.
Q: What will happen now?
The government said HPA would continue to monitor the situation and would regularly review the data and the need for further action.
In the meantime, hospitals should ensure they continue to provide good infection control to prevent any spread, and consider whether patients have recently been treated abroad and send samples to HPA for testing if necessary.
New 'superbug' found in UK hospitals
By Michelle Roberts Health reporter, BBC News
A new superbug that is resistant to even the most powerful antibiotics has entered UK hospitals, experts warn.
They say bacteria which make an enzyme called NDM-1 travelled back with NHS patients who had gone abroad to countries like India and Pakistan for treatments such as cosmetic surgery.
Although there have only been about 50 cases identified in the UK so far, scientists fear it will go global.
Tight surveillance and new drugs are needed says Lancet Infectious Diseases.
NDM-1 can exist inside different bacteria, like E.coli, and it makes them resistant to one of the most powerful groups of antibiotics - carbapenems.
These are generally reserved for use in emergencies and to combat hard-to-treat infections caused by other multi-resistant bacteria.
Continue reading the main story “Start Quote
The fear would be that it gets into a strain of bacteria that is very good at being transmitted between patients”
End Quote Dr David Livermore Researcher from the HPA
And experts fear NDM-1 could now jump to other strains of bacteria that are already resistant to many other antibiotics.
Ultimately, this could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.
At least one of the NDM-1 infections the researchers analysed was resistant to all known antibiotics.
Similar infections have been seen in the US, Canada, Australia and the Netherlands and international researchers say that NDM-1 could become a major global health problem.
Infections have already been passed from patient to patient in UK hospitals.
The way to stop NDM-1, say researchers, is to rapidly identify and isolate any hospital patients who are infected.
Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.
And currently, most of the bacteria carrying NDM-1 have been treatable using a combination of different antibiotics.
But the potential of NDM-1 to become endemic worldwide is "clear and frightening", say the researchers in their Lancet paper.
National alert Dr David Livermore, one of the researchers and who works for the UK's Health Protection Agency (HPA), said: "There have been a number of small clusters within the UK, but far and away the greater number of cases appear to be associated with travel and hospital treatment in the Indian subcontinent.
"This type of resistance has become quite widespread there.
"The fear would be that it gets into a strain of bacteria that is very good at being transmitted between patients."
He said the threat was a serious global public health problem as there are few suitable new antibiotics in development and none that are effective against NDM-1.
The Department of Health has already put out an alert on the issue, he said.
"We issue these alerts very sparingly when we see new and disturbing resistance."
Travel history The National Resistance Alert came in 2009 after the HPA noted an increasing number of cases - some fatal - emerging in the UK.
The Lancet study looked back at some of the NDM-1 cases referred to the HPA up to 2009 from hospitals scattered across the UK.
At least 17 of the 37 patients they studied had a history of travelling to India or Pakistan within the past year, and 14 of them had been admitted to a hospital in these countries - many for cosmetic surgery.
For some of the patients the infection was mild, while others were seriously ill, and some with blood poisoning.
A Department of Health spokeswoman said: "We are working with the HPA on this issue.
"Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.
"So far there has only been a small number of cases in UK hospital patients. The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues."
10 August 2010 Last updated at 22:24 ET
Q&A: NDM-1 superbugs
By Michelle Roberts Health reporter, BBC News
Experts have warned that a new type of drug-resistant superbug is emerging in UK hospitals.
Q: What is NDM-1?
New Delhi metallo-ß-lactamase-1, or NDM-1 for short, is an enzyme that can live inside different bacteria. Any bacteria that carry it will be resistant to carbapenem antibiotics. This is concerning because these antibiotics are some of the most powerful ones, used on hard-to-treat infections that evade other drugs.
Q: Why is this a problem?
NDM-1 (or more precisely the DNA code for this enzyme) can easily now jump from one strain of bacteria to another.
Experts are worried that it may end up in another bacterium which is already resistant to many other antibiotics.
Ultimately, it could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.
Q: Can it be treated?
Other treatment options are available to fight these infections but they present major challenges for clinicians and will often demand combinations of antibiotics are used.
Scientists have identified some strains that have been resistant to all known antibiotics.
Q: How would I know if I had it?
So far, many of the UK cases have been in patients who have recently travelled to India or Pakistan for medical treatment and who caught the infection while there.
But, some of these patients have passed the infection on to others in UK hospitals upon their return.
The infections have ranged from mild to severe - and some have been fatal.
Two types of bacteria have been host to NDM-1: the gut bacterium E.coli and another that can invade the lungs called Klebsiella pneumonia. Both can lead to urinary tract infections and blood poisoning.
Infections such as these would usually be spotted in patients by medics.
Q: Can its spread be stopped?
Experts say the way to stop it is through surveillance, rapid identification and isolation of any hospital patients who are infected.
Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.
NDM-1 is already widespread in the Indian subcontinent and has also reached countries including the US, Canada, Australia and the Netherlands. Scientists believe it has the potential to become a global public health issue.
And they say we now need new drugs to treat resistant strains.
Q: Are there new antibiotics that could help?
While there is a great deal of investment in research to find new antibiotics, experts say that most of the drugs currently in the pipeline will be useless for treating NDM-1 positive patients.
This is because the bacteria that carry NDM-1 are gram-negative, while most of the work is being carried out for gram-positive bugs like MRSA.
The Health Protection Agency says "multi-resistant gram-negative bacteria pose a notable public health risk and it remains important that the pharmaceutical industry continues to work towards developing new treatment options".
The Department of Health said it was investigating ways of encouraging the development of new antibiotics with European colleagues.
Q: What will happen now?
The government said HPA would continue to monitor the situation and would regularly review the data and the need for further action.
In the meantime, hospitals should ensure they continue to provide good infection control to prevent any spread, and consider whether patients have recently been treated abroad and send samples to HPA for testing if necessary.
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