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Now tracking the new emerging South Africa Omicron Variant

A new superbug

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    Posted: August 11 2010 at 4:53am
www.bbc.co.uk

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 live inside different bacteria, like E.coli, and it makes them resistant to one of the most powerf
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Scientists find new superbug spreading from India
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7:54am EDT

By Kate Kelland and Ben Hirschler

LONDON (Reuters) - A new superbug could spread around the world after reaching Britain from India -- in part because of medical tourism -- and scientists say there are almost no drugs to treat it.

Researchers said on Wednesday they had found a new gene called New Delhi metallo-beta-lactamase, or NDM-1, in patients in South Asia and in Britain.

NDM-1 makes bacteria highly resistant to almost all antibiotics, including the most powerful class called carbapenems, and experts say there are no new drugs on the horizon to tackle it.

With international travel in search of cheaper healthcare increasing, particularly for procedures such as cosmetic surgery, Timothy Walsh, who led the study, said he feared the new superbug could soon spread across the globe.

"At a global level, this is a real concern," Walsh, from Britain's Cardiff University, said in telephone interview.

"Because of medical tourism and international travel in general, resistance to these types of bacteria has the potential to spread around the world very, very quickly. And there is nothing in the (drug development) pipeline to tackle it."

Almost as soon as the first antibiotic penicillin was introduced in the 1940s, bacteria began to develop resistance to its effects, prompting researchers to develop many new generations of antibiotics.

But their overuse and misuse have helped fuel the rise of drug-resistant "superbug" infections like methicillin-resistant Staphyloccus aureus (MRSA).

In a study published in The Lancet Infectious Diseases journal on Wednesday, Walsh's team found that NDM-1 is becoming more common in Bangladesh, India, and Pakistan and is also being imported back to Britain in patients returning after treatment.

"India also provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide," the scientists wrote in the study.

"CINDERELLA" BUSINESS

For many years, antibiotic research has been a "Cinderella" sector of the pharmaceuticals industry, reflecting a mismatch between the scientific difficulty of finding treatments and the modest sales such products are likely to generate, since new drugs are typically saved only for the sickest patients.

But the increasing threat from superbugs is encouraging a rethink at the few large drugmakers still actively hunting for new antibiotics, including Pfizer, Merck, AstraZeneca, GlaxoSmithKline and Novartis.

Walsh and his international team collected bacteria samples from hospital patients in two places in India, Chennai and Haryana, and from patients referred to Britain's national reference laboratory between 2007 and 2009.

They found 44 NDM-1-positive bacteria in Chennai, 26 in Haryana, 37 in Britain, and 73 in other sites in Bangladesh, India, and Pakistan. Several of the British NDM-1 positive patients had recently traveled to India or Pakistan for hospital treatment, including cosmetic surgery, they said.

Most worryingly, NDM-1-producing bacteria are resistant to many antibiotics including carbapenems, the scientists said, a class of the drugs often reserved for emergency use and to treat infections caused by other multi-resistant bugs like MRSA and C-Difficile.

Anders Ekblom, global head of medicines development at AstraZeneca, whose Merrem antibiotic is the leading carbapenem, said he saw "great value" in investing in new antibiotics.

"We've long recognized the growing need for new antibiotics, he said. "Bacteria are continually developing resistance to our arsenal of antibiotics and NDM1 is just the latest example."

Experts commenting on Walsh's findings said it was important to be alert to the new bug and start screening for it early.

"If this emerging public health threat is ignored, sooner or later the medical community could be confronted with carbapenem-resistant (bacteria) that cause common infections, resulting in treatment failures with substantial increases in health-care costs," Johann Pitout from the University of Calgary in Canada wrote in a commentary in same journal.

(Editing by Myra MacDonald)

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New Delhi-Metallo-1 (NDM-1) infects 37 people in UK!

hisz.rsoe.hu

A 'superbug' that is resistant to the most powerful antibiotics has reached the UK. Scientists are warning the bug, an enzyme called New Delhi-Metallo-1 (NDM-1), could spread across the world as nothing is being developed to treat it. There has been 37 reported cases in the UK, mainly among patients who travelled to areas of Asia for cosmetic surgery, transplants and cancer treatment.
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Yep, this is scary! I just had an operation not elective so far I am ok. But I hope this is my last operation!

Mother Nature finds a way to thin the popluation!!!
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Good find Coyote.  Looks like this is already off and running.  
 
Going back to the pre-antibiotic era?  That would be interesting.  
 
 
 
 
 
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Thanks buddy..
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We've only got ourselves to blame for the indestructible Indian superbug

< =text/ ="http://s.dailymail.co.uk/js/digg.js">

By Michael Hanlon
Last updated at 11:33 AM on 12th August 2010

To discover just how grim the olden Days were, take a trip back to the 19th century. Witnessing the chronic misery and disease that touched everyone's lives back then, you will quickly realise just how important medicine's two greatest contributions to human welfare have been, namely mass vaccination and antibiotics  -  and give hearty thanks for the fact you live in the 21st century.

But now humanity faces the nightmarish prospect of losing one of them  -  and it's partly thanks to our own recklessness and profligacy.

This week, it is reported that a new strain of drug-resistant bacteria has emerged on the Indian subcontinent. 

Superbug:%20New%20Dehli-Metallo-1,%20seen%20under%20the%20microscope%20could%20be%20untreatable%20for%20as%20long%2010%20years%20while%20scientists%20devise%20the%20right%20kind%20of%20antibiotics

Superbug: New Dehli-Metallo-1, seen under the microscope could be untreatable for as long 10 years while scientists devise the right kind of antibiotics

The germs in question are common gut bacteria, which have been modified by a gene called NDM-1 (New Delhi Metallo-beta-lactamase-1).

Alarmingly, this modification makes bacteria such as E. coli completely resistant to all known antibiotics  -  even to the 'weapon of last resort', a group of drugs called the carbapenems, which are usually held in reserve for grave emergencies and infections by highly-resistant bacteria such as MRSA.

More worryingly, the NDM-1 gene was found to be present on plasmids  -  bits of DNA which can easily be copied and transferred between different species of bacteria.

This suggests, according to the authors of the paper which was published in the Lancet, 'an alarming potential to spread and diversify among bacterial populations'. 

 

For the best part of a century, doctors and the microbes have been engaged in an escalating, expensive and increasingly high-tech arms race. 

Up to now, the medics have mostly had the upper hand, pulling, like rabbits out of a hat, clever new drugs, usually derived from various fungi and moulds (like Penicillin itself) which are a match for the latest strain of bacteria.

But there is a problem. No antibiotic, however potent, is ever completely effective. Like the (unintentionally) worrying TV ad for a disinfectant which 'kills 99 per cent of germs', it is the hard-as-nails 1 per cent that survive the chemical Armageddon that you have to worry about.

Bacteria reproduce, by dividing, at an alarming, exponential rate. And amid this promiscuity the bacteria's genes get spliced and transferred, and mutations are acquired and passed on.

While it can take centuries or millennia for an animal species to visibly evolve new traits, with bacteria new drug-resistant strains can emerge in months or even days, and spread like wildfire. 

Ten years ago, it was the MRSA superbug that hit the headlines. The fear now is that something even nastier is emerging, a new group of drug resistant bacteria which really will spell the beginning of the end of the antibiotic era.

People were predicting this five, ten years ago,' says Professor Mark Enright, an expert in superbugs, who works for a private biotech company developing novel ways to kill bacteria. 'The cat is now out of the bag.'

The evolution of the 'New Delhi' strain is unsurprising. Mass international travel and in particular medical tourism  -  which has seen thousands of people from wealthy countries travelling to places such as India and Pakistan, often for cheap plastic surgery  -  has led to the rapid evolution and spread of diseases such as this.

In just three years, the NDM-1 gene has gone from being hardly detectable, to present in 1-3 per cent of all Indian patients with common gut bacterial infections  -  a 'staggering' increase according to Professor Tim Walsh of Cardiff University, the lead author of the Lancet' s Infectious Diseases paper.

But we can't just blame the pernicious spread of medical tourism, often driven by vanity rather than need, for the emergence of this new strain. With antibiotics, humanity as a whole has been utterly reckless.

Knowing what we know now, if we could go back in time we would have prescribed antibiotics sparingly and only when they were really needed.

If we had done that, we may not have been facing the prospect of superbugs for the next 100 years.

Instead, antibiotics have been massively overprescribed, thrown willy-nilly at patients by harassed and time-pressed doctors for a host of minor ailments  -  often coughs and colds that aren't even caused by bacteria in the first place.

As Professor Enright says: 'Every time you throw enough antibiotics at enough people, you encourage the evolution of drug-resistant mutants.'

This happens everywhere, from GP surgeries in Britain and the U.S.  -  where antibiotics are the medicine of choice for just about every minor childhood snuffle  -  to India, where antibiotics are available cheaply over the counter without a prescription.

Here, there is no need for even a rudimentary diagnosis. They are guzzled by millions every day.

So, what can be done? In India, as Professor Enright says, probably nothing; the cat is, indeed, out of the bag.

In the UK, only comprehensive monitoring and, if necessary, isolation and quarantine are likely to be effective.

Sadly, these measures are not cheap and in an increasingly cash-strapped NHS unlikely to be adopted with any rigour.

Some doctors have called for all patients who have received medical treatment in India to be screened on arrival in their home country. Several cases of NDM-1 have been found in British patients who went to India for both urgent medically needed surgery and cosmetic procedures.

Such a measure would undoubtedly be sensible. But, unfortunately, screening those returning globetrotters who hold UK passports would present probably insurmountable legal and financial hurdles.

Fortunately, the bacteria in question (unlike the staphylococcus MRSA strain) are not particularly virulent. We are not going to see a wave of deaths among otherwise healthy people as a result of drug-resistant E.coli, for instance.

But for people in hospital, with weakened immune systems and with infected wounds, this could turn into a real issue.

Ultimately, we will need new antibiotics  -  and even completely new ways of killing bacteria.

Professor Enright's team at Biocontrol Ltd are working on a new take on an old idea  -  using natural viruses to attack bacteria instead of antibiotics.

Clinical trials are under way and we could have a new weapon in our armoury within three to ten years.

Sadly, developing new antibiotics is both expensive and financially unrewarding.

While a new painkiller or anti-inflammatory drug can make a drug company billions, a new antibiotic, especially one which by its very nature should be held in reserve and only prescribed in small quantities, will probably not turn a profit for anyone.

As with vaccines (which are also expensive to develop, and often generate little return) we need a new economic model for the development of such drugs.

We also need to rethink the policy of sending patients abroad for operations.

It is easy to imagine that in a few decades we will look back upon the era from 1940 to maybe the 2020s as a golden age, one in which we had infectious disease at bay.

Maybe we will find yet another rabbit to pull out of the hat; human ingenuity knows, after all, few bounds. But if not, we probably have only our own profligacy to blame.

In the war against the bacteria, humanity would have done well to keep its powder dry. 



Read more: http://www.dailymail.co.uk/health/article-1302358/NDM-1-Were-blame-indestructible-Indian-superbug.html#ixzz0wyHht9Fh
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mary008 Quote  Post ReplyReply Direct Link To This Post Posted: August 13 2010 at 10:50pm
.
 
 
 
 
.
 
 
 
 
 "When India is emerging as a medical tourism destination, this type of news is
 
unfortunate and may be a sinister design of multi-national companies," said Hindu-
 
nationalist MP SS Ahluwalia.
 
 
 

New Delhi-Metallo-1
...........................................
 
 
India angry over medical 'superbug' study
.................................................................................
.............................................................................................
 
 

...The NDM-1 gene was first identified last year by Cardiff University's Timothy Walsh in two
 
types of bacteria -- Klebsiella pneumoniae and Escherichia coli -- in a Swedish patient
 
admitted to hospital in India.
 
 
 
 
 
 
............................................................................................................................................
 
 
 
 
 
 
Escherichia coli
and Klebsiella
pneumoniae

Carbapenemase
in Long-term Care
Facility, Illinois, USA

...........................................
 
 

Excerpts-

...Within the
United States, carbapenem-resistant E.
coli carrying blaKPC has been isolated
in New Jersey (3) and Cleveland, Ohio
(4), and 7 carbapenem-resistant E. coli
isolates were obtained from 3 different
hospitals in Brooklyn, New York
(5). Urban et al. (6) recently reported
9 KPC-2 and KPC-3 carbapenemases
in urinary E. coli isolates from 7 longterm
care facilities. We report such an
isolate from a resident of a long-term
care facility.
This case involved a 68-year-old
female resident of a long-term care
facility in Centralia, Illinois, who had
multiple chronic medical problems,
including cerebral palsy, a seizure
disorder, and recurrent urinary tract
infections.
 
 

...Our case, like that of Urban et al.
(6), involved a urinary isolate from a
resident of a long-term care facility.
As increasing numbers of resistant
gram-negative rods colonize such
patients, the patients may acquire a
bacterium carrying a KPC plasmid
conferring broad-spectrum resistance
as described in our patient. These plasmids
may then be laterally transferred
to other gram-negatives, which may
have occurred in this case.
Our case underscores the gravity
of the evolutionary process of emergent,
multidrug�resistant enterobacteriaceae.
Even though E. coli strains
that harbor carbapenemase genes are
not ubiquitous, additional therapeutic
interventions are needed to prevent
the spread of these bacteria, which are
likely to infect increasing numbers of
patients.
 
 
 
..................................................................................................................................
 
excerpt-

Medication
The following is a discussion on the specific agents used in the antimicrobial therapy of Klebsiella infections. In vitro data show that a wide range of beta-lactams, aminoglycosides, quinolones, and other antibiotics are useful for treatment of klebsiellae infections.4,5,6
 
Cephalosporins have been widely used as monotherapy and in combination with aminoglycosides. Cephalosporins should be avoided if ESBL strains are present. In such instances, the carbapenems, especially imipenem, are effective.
Aztreonam and quinolones are useful in patients allergic to penicillin, and rifampin has been used for treatment of rhinoscleroma. TMP/SMZ is not used in primary treatment of pneumonia. They may be used as initial treatment in uncomplicated UTI and as second-line agents for ozena.

Antibiotics
Therapy must cover all likely pathogens in the context of this clinical setting. Antibiotic selection should be guided by culture and sensitivity results whenever feasible.
 
Cefotaxime (Claforan)
Useful for most Klebsiella infections. Third-generation cephalosporin with gram-negative activity. Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth.
 
 
 
.......................
 
 
 
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 see below...
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metallo-beta-lactamase 1 
 
NDM-1 Is an ENZYME that can live in Many Bacteria.
 
 
 
From-
 
 
Health Protection Scotland
.............................................
 
Travel Health
.......................
 
 
 
08 July 2009

Multi-resistant hospital bacteria linked to India and Pakistan

A National Resistance Alert, issued by the HPA in January 2009, warned of an increasing number of carbapenem-resistant strains of Enterobacteriaceae being identified in UK hospital patients, a significant proportion of whom had received medical treatment abroad.

 
Three categories of carbapenem-destroying enzymes (‘carbapenemases’) were recognised among submissions during 2008 and deemed to be of potential major public health concern by the HPA Centre for Infection’s Antibiotic Resistance Monitoring and Reference Laboratory (ARMRL).

It has now become clear that a further metallo-beta-lactamase type – designated NDM-1 (‘New Delhi Metallo-1’) - is swiftly emerging. Four isolates producing this enzyme have been recognised among submissions from 2008, with 18 more so far in 2009. The total of 22 bacteria with NDM-1 enzyme represent the largest single group of carbapenemase producers referred to ARMRL and comprise K. pneumoniae (14), Escherichia coli (four), Citrobacter freundii (two), Enterobacter cloacae (one) and Morganella morganii (one) from 19 patients at 17 hospitals. Typing by the HPA’s Laboratory for Healthcare Associated infections shows that they are clonally diverse, with no outbreaks and only one instance of possible transmission between two patients.

ARMRL data suggest that isolates with NDM-1 enzyme have been repeatedly imported to the UK from the Indian subcontinent, though there may now also be UK circulation since some affected patients have no immediately identifiable overseas links. This situation resembles that with producers of VIM and KPC carbapenemases

 
where multiple importations have been seen via patients previously hospitalised in Greece, Cyprus and Israel along with locally acquired infections.
 
However the population flow between the UK and the Indian subcontinent is larger with some elective medical tourism as well as some patients who, for family reasons, divide treatment between the UK and India or Pakistan.

Carbapenems are the only antibiotics reliably active against many otherwise multi-resistant gram-negative opportunist bacteria, particularly those with extended-spectrum beta-lactamases (ESBLs). The growing emergence and diversity of carbapenemase-producing strains is therefore a major concern.

Treatment presents major challenges. Most isolates with NDM-1 enzyme are resistant to all standard intravenous antibiotics for treatment of severe infections. ARMRL is urgently reviewing the activity of both developmental and old, otherwise abandoned, antibiotics against producers.

ARMRL is therefore urging hospitals to be vigilant to multi-resistant gram-negative bacteria in patients with recent hospital contact in the Indian subcontinent as well as the Eastern Mediterranean. If Enterobacteriaceae are found resistant to any carbapenem they should be sent to ARMRL for investigation while any isolates in Scotland should be reported to HPS via ECOSS. Great care should be taken to prevent onward transmission of producers. [Source: Health Protection Report, 3 July 2009. http://www.hpa.org.uk/hpr/archives/2009/news2609.htm#ndm1]

Vol: 43 No: 27 Year: 2009 Page:
 
 
............................................................
 
 
 
 
 
So... is it an engineered enzyme? let loose on the environment?
 
 Like the one used to break down tar balls?
 
 
 
 
 
 
 
 
Chin Med J (Engl). 2008 Sep 5;121(17):1611-6.
 
Characterization of multidrug-resistant and metallo-beta-lactamase-producing
 
Pseudomonas aeruginosa isolates from a paediatric clinic in China.
 
 
......
 
 
 
 
Pseudomonas aeruginosa is a common bacterium
 
 
which can cause disease in humans and non-human animals. It is found in soil, water, skin flora, and most man-made environments throughout the world. It thrives not only in normal atmospheres, but also with little oxygen, and has thus colonized many natural and artificial environments.
 
 
It uses a wide range of organic material for food; in animals, the versatility enables the organism to infect damaged tissues or people with reduced immunity.
 
 
The symptoms of such infections are generalized inflammation and sepsis. If such colonizations occur in critical body organs such as the lungs, the urinary tract, and kidneys, the results can be fatal.[1] Because it thrives on most surfaces, this bacterium is also found on and in medical equipment including catheters, causing cross infections in hospitals and clinics.
 
 
It is implicated in hot-tub rash.
 
 
It is also able to decompose hydrocarbons and has been used to break down tarballs and oil from oil spills.[2][3]
 
 
 
 
2 yrs ago...
 
 

Chin Med J (Engl). 2008 Sep 5;121(17):1611-6.
 
Characterization of multidrug-resistant and metallo-beta-lactamase-producing Pseudomonas aeruginosa isolates from a paediatric clinic in China.
 

Dong F, Xu XW, Song WQ, Lü P, Yu SJ, Yang YH, Shen XZ.
Microbiology Laboratory, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Abstract
BACKGROUND:

In the present study, we characterized multidrug-resistant Pseudomonas aeruginosa (MDRP) clinical isolates from a paediatric facility and

investigated the types and features of the metallo-beta-lactamases (MBLs)
produced by carbapenem-resistant strains.
 

METHODS: Four hundred and ninety-eight strains of Pseudomonas aeruginosa were isolated from patients at Beijing Children's Hospital between January 2005 and December 2006.
 
 
The minimal inhibition concentrations (MICs) of the strains for 13 antibiotics were measured. A combination of the E test and PCR amplification/DNA sequencing was used to define the carbapenem-resistant strains.
 
 
 RESULTS: We found that 24.1% (120/498) of the isolates were MDRP.
 
 
The frequencies of resistance to imipenem and meropenem were 34.2% and 35.8%, respectively, and the MIC50 and MIC90 values for the two antibiotics were identical at 4 microg/ml and 32 microg/ml, respectively. The detection rate for carbapenem resistance was 49.2% (59/120).
 
 
 
Among the 59 carbapenem-resistant Pseudomonas aeruginosa strains, 39 (66.1%) were positive for the MBL genotype;
 
 
35 (89.7%) strains carried the bla(IMP) gene and 4 (10.3%) strains carried the bla(VIM) gene. Neither bla(SPM) nor bla(GIM) was amplified from any of the 59 isolates.
 
 
DNA sequencing revealed that IMP-1 was present in 35 IMP-producing isolates
 
 
and VIM-2 was detected in four VIM-producing isolates.
 
 
 
 CONCLUSIONS: These MDRP isolates exhibited high frequencies of resistance to carbapenems among clinical isolates from a paediatric facility in Beijing, China.
 
 
The production of MBL appears to be an important mechanism for carbapenem resistance in Pseudomonas aeruginosa.
 
 
PMID: 19024085 [PubMed - indexed for MEDLINE]Free Article
 
 
 
 
...............................................
 
Pseudomonas aeruginosa is a common bacterium which can cause disease in humans and non-human animals. It is found in soil, water, skin flora, and most man-made environments throughout the world. It thrives not only in normal atmospheres, but also with little oxygen,
 
 
and has thus colonized many natural and artificial environments. It uses a wide range of organic material for food; in animals, the versatility enables the organism to infect damaged tissues or people with reduced immunity. The symptoms of such infections are generalized inflammation and sepsis. If such colonizations occur in critical body organs such as the lungs, the urinary tract, and kidneys, the results can be fatal.[1] Because it thrives on most surfaces,
 
 
 this bacterium is also found on and in medical equipment including catheters, causing cross infections in hospitals and clinics. It is implicated in hot-tub rash. It is also able to decompose hydrocarbons and has been used to break down tarballs and oil from oil spills.[2][3]
 
 
 
wikipedia
 
 
File:Pseudomonas%20aeruginosa%2001.jpg
 
 
 
 

........................................
 
 
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< id=Uid19554400 = value=19554400 name=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.uid sid="3">3.

Nationwide surveillance of bacterial respiratory pathogens conducted by the Japanese Society of Chemotherapy in 2007: general view of the pathogens' antibacterial susceptibility.

Niki Y, Hanaki H, Matsumoto T, Yagisawa M, Kohno S, Aoki N, Watanabe A, Sato J, Hattori R, Terada M, Koashi N, Kozuki T, Maruo A, Morita K, Ogasawara K, Takahashi Y, Watanabe J, Takeuchi K, Fujimura S, Takeda H, Ikeda H, Sato N, Niitsuma K, Saito M, Koshiba S, Kaneko M, Miki M, Nakanowatari S, Honda Y, Chiba J, Takahashi H, Utagawa M, Kondo T, Kawana A, Konosaki H, Aoki Y, Ueda H, Sugiura H, Ichioka M, Goto H, Kurai D, Okazaki M, Yoshida K, Yoshida T, Tanabe Y, Kobayashi S, Okada M, Tsukada H, Imai Y, Honma Y, Nishikawa K, Yamamoto T, Kawai A, Kashiwabara T, Takesue Y, Wada Y, Nakajima K, Miyara T, Toda H, Mitsuno N, Sugimura H, Yoshioka S, Kurokawa M, Munekawa Y, Nakajima H, Kubo S, Ohta Y, Mikasa K, Maeda K, Kasahara K, Koizumi A, Sano R, Yagi S, Takaya M, Kurokawa Y, Kusano N, Mihara E, Kuwabara M, Fujiue Y, Ishimaru T, Matsubara N, Kawasaki Y, Tokuyasu H, Masui K, Negayama K, Ueda N, Ishimaru M, Nakanishi Y, Fujita M, Honda J, Kadota J, Hiramatsu K, Aoki Y, Nagasawa Z, Suga M, Muranaka H, Yanagihara K, Fujita J, Tateyama M, Sunakawa K, Totsuka K.

J Infect Chemother. 2009 Jun;15(3):156-67. Epub 2009 Jun 25.PMID: 19554400 [PubMed - indexed for MEDLINE]Related citations

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Nosocomial outbreak by imipenem-resistant metallo-beta-lactamase-producing Pseudomonas aeruginosa in an adult intensive care unit in a Brazilian teaching hospital.

Cezário RC, Duarte De Morais L, Ferreira JC, Costa-Pinto RM, da Costa Darini AL, Gontijo-Filho PP.

Enferm Infecc Microbiol Clin. 2009 May;27(5):269-74. Epub 2009 Apr 21.PMID: 19386392 [PubMed - indexed for MEDLINE]Related citations

< id=Uid18603681 = value=18603681 name=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.uid sid="5">5.

Incidence of metallo-beta-lactamase-producing Pseudomonas aeruginosa in diabetes and cancer patients.

Varaiya A, Kulkarni M, Bhalekar P, Dogra J.

Indian J Pathol Microbiol. 2008 Apr-Jun;51(2):200-3.PMID: 18603681 [PubMed - indexed for MEDLINE]Free ArticleRelated citations

< id=Uid17491203 = value=17491203 name=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.uid sid="6">6.

[Incidence and resistance patterns of pathogens from lower respiratory tract infections (LRTI)]

Dorobăţ OM, Moisoiu A, Tălăpan D.

Pneumologia. 2007 Jan-Mar;56(1):7-15. Romanian. PMID: 17491203 [PubMed - indexed for MEDLINE]Related citations

< id=Uid17059876 = value=17059876 name=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.uid sid="7">7.

Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: report from the SENTRY Antimicrobial Surveillance Program (1998-2004).

Moet GJ, Jones RN, Biedenbach DJ, Stilwell MG, Fritsche TR.

Diagn Microbiol Infect Dis. 2007 Jan;57(1):7-13. Epub 2006 Oct 23.PMID: 17059876 [PubMed - indexed for MEDLINE]Related citations

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[Comparison of 3 commercial metallo-beta-lactamase detection kits]

Shigetaka M, Muratani T, Kobayashi T, Ohkubo K, Matsumoto T.

Kansenshogaku Zasshi. 2006 Jul;80(4):391-8. Japanese. PMID: 16922482 [PubMed - indexed for MEDLINE]Related citations

< id=Uid16161752 = value=16161752 name=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.uid sid="9">9.

[Surveillance of susceptibility of clinical isolates to panipenem between 2000 and 2003]

Abe T, Koga T, Sato Y, Ito K, Tochikawa Y.

Jpn J Antibiot. 2005 Jun;58(3):231-58. Japanese. PMID: 16161752 [PubMed - indexed for MEDLINE]Related citations

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[In vitro susceptibilites to levofloxacin and various antibacterial agents of 11,475 clinical isolates obtained from 52 centers in 2002]

Yamaguchi K, Ohno A, Ka****ani F, Iwata M, Kanda M, Tsujio Y, Shimoyama N, Okujima H, Ito M, Kawaguchi H, Chiba H, Akizawa K, Katayama Y, Sugimoto K, Tashiro H, Kaimori M, Suwabe A, Obata R, Sugiyama T, Toyoshima S, Kato J, Kaku M, Kanemitsu K, Kunishima H, Okada J, Tazawa Y, Igari J, Oguri T, Watanabe K, Kobayashi Y, Uchida H, Totsuka K, Kon S, Nakamura K, Matsuda K, Hayashi I, Shiotani J, Shiotani J, Kanno H, Itoh A, Sumitomo M, Uchida T, Kawabata A, Oiwa C, Iwata M, Horii T, Ishigo S, Yoshimura T, Ichiyama S, Wada Y, Kimura S, Maesaki S, Itoh K, Noda Y, Yama****a T, Yamaguchi I, Kageyama F, Shaku E, Baba H, Inuzuka K, Okabe H, Tatewaki K, Moro K, Aihara M, Matsushima T, Niki Y, Kuw Abara M, Ikawa S, Tanaka M, Hinoda Y, Sugiura T, Kamioka M, Ono J, Takata T, Makino H, Murase M, Miyamoto H, Aizawa H, Honda J, Takii M, Nagasawa Z, Aoki Y, Hamazaki N, Tsutsui T, Nakagawa K, Iwata M, Hiramatsu K, Saikawa T, Yamane N, Kimoto H, Kotani T, Kageoka T, Hongo T, Masuda J, Miyanohara H, Tsujimura M, Yasujima M, Hayashi I.

Jpn J Antibiot. 2005 Feb;58(1):17-44. Japanese. PMID: 15849869 [PubMed - indexed for MEDLINE]Related citations

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Metallo-beta-lactamase-producing Gram-negative bacilli in Korean Nationwide Surveillance of Antimicrobial Resistance group hospitals in 2003: continued prevalence of VIM-producing Pseudomonas spp. and increase of IMP-producing Acinetobacter spp.

Lee K, Ha GY, Shin BM, Kim JJ, Kang JO, Jang SJ, Yong D, Chong Y; Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) group.

Diagn Microbiol Infect Dis. 2004 Sep;50(1):51-8.PMID: 15380278 [PubMed - indexed for MEDLINE]Related citations

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[Antibacterial activity of panipenem against clinical isolates in 2000 and 2001]

Abe T, Fukuoka T, Sato Y, Ito K, Sei M.

Jpn J Antibiot. 2002 Dec;55(6):808-26. Japanese. PMID: 12621735 [PubMed - indexed for MEDLINE]Related citations

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Metallo-beta-lactamase producers in environmental microbiota: new molecular class B enzyme in Janthinobacterium lividum.

Rossolini GM, Condemi MA, Pantanella F, Docquier JD, Amicosante G, Thaller MC.

Antimicrob Agents Chemother. 2001 Mar;45(3):837-44.PMID: 11181369 [PubMed - indexed for MEDLINE]Free PMC ArticleFree textRelated citations

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Multifocal outbreaks of metallo-beta-lactamase-producing Pseudomonas aeruginosa resistant to broad-spectrum beta-lactams, including carbapenems.

Senda K, Arakawa Y, Nakashima K, Ito H, Ichiyama S, Shimokata K, Kato N, Ohta M.

Antimicrob Agents Chemother. 1996 Feb;40(2):349-53.PMID: 8834878 [PubMed - indexed for MEDLINE]Free PMC ArticleFree textRelated citations

 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Mary008 Quote  Post ReplyReply Direct Link To This Post Posted: August 14 2010 at 1:47am
.
more on...
 
 
 multidrug-resistant and metallo-beta-lactamase-producing
 
Pseudomonas aeruginosa isolates
 
 
 
taken from above...    many like this but you have to click on titles and find it in the text...
 
 
 
Jpn J Antibiot. 2005 Jun;58(3):231-58.
 
[Surveillance of susceptibility of clinical isolates to panipenem between 2000 and 2003]
[Article in Japanese]

...The findings of this surveillance indicate that it is necessary to pay careful attention to the trends of resistant bacteria such as PRSP, BLNAR, and metallo-beta-lactamase producing strains.
 
 
................
 
 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: August 14 2010 at 7:12am
died from a leg injury? 
 
 

South Asian superbug claims first life

August 15, 2010

    The victim picked up the bug in a hospital in Pakistan and died in June, said a doctor from the Brussels hospital where he had been treated.

    "He was involved in a car accident during a trip to Pakistan. He was hospitalised with a major leg injury and then repatriated to Belgium, but he was already infected," the doctor said. Despite being treated with a powerful antibiotic, the patient died.

    It was reported last week that the superbug had spread to Australia, infecting three people who had travelled to India for surgery.

    Professor Peter Collignon, Canberra Hospital's head of infectious diseases, said the cases were just the "tip of the iceberg". One patient had plastic surgery in Mumbai.

    "We found this multi-resistant, untreatable bug in their urine, luckily not causing too many problems. But it's a real problem if it spreads to others," he said. "The germ we had was untreatable."

    The superbug – in bacteria with the New Delhi metallo-lactamase-1 (NDM-1) gene – was identified last year in a Swedish patient in India.

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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: August 16 2010 at 12:03pm
    Deadly, Antibiotic-Resistant NDM-1 Enzyme Found in Germany, Bild Reports
     
    An enzyme which makes bacteria resistant to "almost all antibiotics" has reached Germany, Bild said, citing information from the Robert Koch Institute, the federal institution responsible for disease control and prevention.

    There have been �individual, isolated proofs of bacteria that produce" the gene, New Delhi-metallo-beta-lactamose (NDM- 1), the newspaper said, quoting the Institute.

    The news follows the first death in continental Europe caused by NDM-1, Bild said. A man died in Brussels having fallen ill after returning from Pakistan, the newspaper reported, citing Denis Pierard, a microbiologist from University Hospital Brussels. Most appearances of the enzyme have so far occurred in India and Pakistan, the newspaper said.

     
    "In a time of universal deceit, telling the truth is a revolutionary act."   G Orwell
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: August 16 2010 at 12:10pm

    Labeled New Delhi metallo-beta-lactamase, better known as NDM-1, the "superbug" has the potential of spreading around the world, and scientists say there are almost no drugs in the pipeline to treat it.

    "It's a major public concern nationwide as well as worldwide knowing there is an uncontrollable gene in circulation," said Dr. Brad Spellberg, infectious disease specialist, scientist, author and researcher at the David Geffen School of Medicine at UCLA and Harbor/UCLA Medical Center in Los Angeles. "Our industry is not developing any new antibiotics to combat this medical urgency."

     
    Full article
     
    "In a time of universal deceit, telling the truth is a revolutionary act."   G Orwell
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: August 17 2010 at 5:56am
     

    22 superbug cases in just one hospital

    MUMBAI: Twenty-two patients in three months in a single hospital. This statistic should serve as an answer to anyone who wants to understand why the NDM-1 (New Delhi metallo-beta-lactamase-1) is creating ripples — both within India and in the rest of the world.

    Hinduja Hospital in Mahim isolated the super bacteria in 22 patients within a span of three months. This has happened within a year of the bacteria being isolated for the first time by European doctors in a Swedish patient who had travelled to New Delhi for an operation.

    "If a single hospital can isolate such a significant number of bacteria with a new resistance gene in a short period of time; the data from all the Indian hospitals, if available would potentially be more interesting and shocking than the human genome project data, which is considered as a discovery more important than the moon landing itself," wrote Dr Abdul Ghafar K, consultant in infectious diseases at Apollo Hospital, Chennai, in an editorial in JAPI, one of the leading Indian research journals.

    A senior microbiologist from
    Mumbai who doesn't want to be named believes that mutations in bugs — to create superbugs — can only occur in countries like India where antibiotics are routinely overused or abused.
    But Dr Abhay Chaudhary, president of the Indian Association of Medical Microbiologists believes that the European conclusion that it originated from the Indian subcontinent is not substantiated. "Some of the extrapolations in the study which appeared in the study that appeared in the Lancet Infectious Diseases journal are inappropriate," he said.

    While the truth about NDM-1's origins remain debatable, there are few things most Indian doctors agree upon: widespread abuse and overuse of antibiotics and the subsequent resistance in the community. In his JAPI article in March, Dr
    Ghafur wrote, "Our country, India, is the world leader in antibiotic resistance; in no other country antibiotics been misused to such an extent."


    Read more:
    22 superbug cases in just one hospital... - India - The Times of India http://timesofindia.indiatimes.com/india/22-superbug-cases-in-just-one-hospital/articleshow/6313069.cms#ixzz0wrprMIO4
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: August 17 2010 at 6:08am

    NDM-1 - is it the death knell for medical tourism?


    Letters
    THE MEDICAL SENTINEL

    Medical tourism, long ostracized as an evil third world nations with limited health-care resources should not be dabbling in, may have finally met its fatal match. Last week, the British based, Lancet Infectious Diseases Journal reported the emergence of highly resistant bacteria carrying a new gene termed New Delhi Metallo-beta-lactamase (NDM-1) and specifically associated it with medical tourism as the bacteria seems to have originated in patients frequenting India and Pakistan for procedures such as cosmetic and transplant surgery. NDM-1 is actually an enzyme that is produced by bacteria. The ability of bacteria to produce NDM-1 is apparently the result of mobile genes that can readily jump from various different bacterial populations allowing them to incorporate these special genes into their chromosomes.

    The danger of NDM-1 is that it can fight against most known antibiotics known to man, thereby rendering the human species defenseless against these superbugs. It was first discovered in December 2009 by Yong and associates who described them in a Swedish national who fell ill with an antibiotic-resistant bacterial infection that he acquired in India. The infection was unsuccessfully treated in a New Delhi hospital and after the patient’s repatriation to Sweden, the gene was identified there.

    The two key authors of the Lancet paper, Karthikeyan Kumarasamy and Timothy Walsh attribute the new strain as a result of antibiotic abuse and global travel. In particular, the resistant bacteria appear to have evolved in third world nations where usage of antibiotics is poorly supervised. Further in countries like China, Indonesia, India, Bangladesh, Pakistan, Thailand, Mexico and even perhaps Malaysia all fingers appear to point to patients themselves who tend to shop around for doctors hoping for that miracle antibiotic that will cure their infection and in the process help genes like NDM -1 to evolve. Walsh pointedly, in his article anointed the blame to India and Pakistan and to medical tourism, although his postgraduate student and lead author, Kumarasamy, originally from the Medical College of Madras and now based at Cardiff appeared to want to distance himself from these inferences to avoid embarrassing his native India.

    Indian medical authorities themselves are in a state of denial, ignoring the clear evidence that points to NDM-1’s origin in Indian private hospitals. The Indian medical community is up in arms for even naming the gene after the nation’s capital New Delhi, although the norm in microbiology has always been that new genes be named after the place of origin. Indian authorities are variously describing the clear impact of the Lancet article as a ‘conspiracy’ and an attack on the country’s lucrative medical tourism industry. However they are on thin ice as it turns out, that not only two of the authors were from India’s Apollo Hospital, long seen as the bastion of Indian medical tourism but in fact they had already been pre-warned by Dr K. Abdul Ghafur, himself a consultant in infectious diseases at the Apollo Hospital, Chennai.

    Ghafur, in a signed article titled “An obituary-Death of Antibiotics” in the Journal of Association of Indian Physicians (JAPI) in March this year was already complaining about the Indian approach to tackling NDM-1. He observed: “The easiest way of tackling the superbug problem is to use the notorious ostrich strategy, which denies the existence of the problem – stop looking for these bugs, stop looking for the hidden resistance mechanisms and closing your eyes even if you find them”. Let’s hope Malaysia will not adopt similar strategies. The same issue of JAPI carried a study by Dr P. Deshpande from Hinduja National Hospital, Mumbai, reporting the isolation of 22 NDM-1 producing bacteria in just three months. “If a single hospital can isolate such a significant number of bacteria with a new resistance gene in a short period of time, the data from all Indian hospitals, if available would potentially be more interesting and shocking than the human genome project data,” Ghafur wrote.

    Walsh in his Lancet article himself concludes that bacteria with NDM-1 are highly resistant to many antibiotic classes and potentially herald the end of treatment with the main antibiotic classes for the treatment of infections. He further quotes Ghafur again who highlighted the widespread non-prescription use of antibiotics in India and predicts that the NDM-1 problem is likely to get substantially worse in the foreseeable future. Even more disturbing is that most of the Indian isolates from Chennai and Haryana were from community-acquired infections, suggesting that NDM-1 is widespread in the environment.

    Given the historical links between India and the UK, it was unsurprising that the UK is the first western country to register the widespread presence of NDM-1-positive bacteria. However, it is not the only country affected. In addition to the first isolate from Sweden, a NDM-1-positive isolate was recovered from a patient who was an Australian resident of Indian origin and had visited Punjab in late 2009. These conclusions make one ponder if NDM-1 already exists in the many Malaysian patients who frequent India for medical treatment, the many Indonesian patients who frequent Malaysia for treatment and the many Malaysian patients who frequent Singapore for their medical therapy.

    Several of the UK source patients had undergone elective, including cosmetic surgery while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and NDM-1 will likely spread worldwide. Walsh cautions the calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money. Such a proposal might ultimately cost the NHS substantially more than the short-term saving and he has strongly advised against such proposals. The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide, are clear and frightening.

    Following the Lancet article, the UK’s Guardian, in their ominously titled article, “Are you ready for a world without antibiotics?” warn that in the very near future, we’re going to have to learn to live without them once again. The era of antibiotics is coming to a close and the post-antibiotic apocalypse is within sight. Since antibiotics are generally for short term use, Big Pharma has shown little enthusiasm in developing new antibiotics as there is just not much money in it.

    The implications of a world without antibiotics are wide. A lot of modern medicine would become impossible if the ability to treat infections is lost. This is especially so in transplant and cancer surgery. Surgery will be thrown back to the pre Fleming era of 1928 when penicillin was discovered. Apart from NDM 1-producing bacteria, an enzyme called KPC has spread in the US (and in Israel and Greece) which also gives bacteria resistance to the carbapenems, the most powerful group of antibiotics we (once) had.

    So the game now is to keep bacteria at bay. Hygiene is an obvious weapon. Better cleaning, hand gels and stern warnings to staff and public alike have helped reduce infection rates in hospitals. Beyond that, there is a real need to conserve those antibiotics we have. Walsh’s report shows that the battle to control the emergence of antibiotic-resistant superbugs through appropriate use of antibiotics must be fought at an international level. It illustrates the importance of considering health issues as a world issue – how antibiotics are prescribed and controlled in one part of the world can very rapidly have consequences elsewhere. What happens when antibiotics don’t work? The Guardian has listed the following:

    • Transplant surgery becomes virtually impossible.

    • Removing a burst appendix becomes a dangerous operation once again.

    • Pneumonia becomes once more “the old man’s friend”.

    • Gonorrhea becomes hard to treat.

    • Tuberculosis becomes incurable

    Malaysia which is still grappling with problems like dengue and worse still the re-emergence of “old” diseases like malaria, TB and leptospirosis, the Lancet report cannot have come at worser time. Malaysia’s nationalized but understaffed healthcare system is already lacking experienced personnel in almost every field of medicine. A world without effective antibiotics will not only sound the death knell for medical tourism right from Singapore through Malacca and Penang, but our hospitals and ICUs can potentially be flooded with patients afflicted with serious infections with surgery or any invasive procedure being virtually impossible to perform. It also highlights what a fragile world we actually live in. It may not necessarily take a tsunami, massive earthquake or a giant meteor to wipe out the human race. It may only require a single gene – like the NDM-1.

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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mary008 Quote  Post ReplyReply Direct Link To This Post Posted: August 19 2010 at 1:30pm
     

    needs beefing up...

     
     
    Differences in healthcare provider standards around the world have been recognised by the World
    Health Organization, and in 2004 it launched the World Alliance for Patient Safety. This body assists
    hospitals and government around the world in setting patient safety policy and practices that can
    become particularly relevant when providing medical tourism services.[28]
     
    wikipedia
     
     
     
     
     
    If the spread of it is massive... we would have seen that by now.... as there has been
     
     "concern" since at least 2005.... 5 yrs ago.  and surveillence between...  2000 and 2003
     
     
    Jpn J Antibiot. 2005 Jun;58(3):231-58.
     
    [Surveillance of susceptibility of clinical isolates to panipenem
     
    between 2000 and 2003]

    [Article in Japanese]

    ...The findings of this surveillance indicate that it is necessary to pay careful
     
    attention to the trends of resistant bacteria such as PRSP, BLNAR, and metallo-
     
    beta-lactamase producing strains.

    http://www.ncbi.nlm.nih.gov/pubmed/16161752
     
     
    ...............
     
     
     
    Mary008
     
     
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mary008 Quote  Post ReplyReply Direct Link To This Post Posted: August 19 2010 at 1:41pm
    .
     
     
     
     
    This is also not Rampant in cases of Medical Tourism...  or it would be plastered all over the news.
     
     
     
     
     
     
    Methicillin-resistant Staphylococcus aureus
     
     
     
     
    Methicillin-resistant Staphylococcus aureus
     
     
     
     
    and this is also not Rampant in Medical Tourism...
     
     
    Necrotizing fasciitis
     
     wikipedia

    ( Flesh-eating bacteria syndrome )
     
     
     

    The infection begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent. Patients usually complain of intense pain that may seem in excess given the external appearance of the skin. With progression of the disease, tissue becomes swollen, often within hours. Diarrhea and vomiting are also common symptoms.

    In the early stages, signs of inflammation may not be apparent if the bacteria are deep within the tissue. If they are not deep, signs of inflammation, such as redness and swollen or hot skin, show very quickly. Skin color may progress to violet, and blisters may form, with subsequent necrosis (death) of the subcutaneous tissues.

    Patients with necrotizing fasciitis typically have a fever and appear very ill. Mortality rates have been noted as high as 73 percent if left untreated.[4] Without surgery and medical assistance, such as antibiotics, the infection will rapidly progress and will eventually lead to death.[5]

     
    ......................
     
     
    Mary008
     
     
    (thanks )
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote jandressup Quote  Post ReplyReply Direct Link To This Post Posted: September 07 2010 at 2:57pm
    Do you have the link??
    If you have one foot on yesterday...and one foot on tomorrow...You are "piddling" on today!....Take time to smell the Flowers....







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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: September 10 2010 at 9:32am
    Japan plans nationwide survey for NDM-1 superbug
     
    Tue Sep 7, 12:07 pm ET

    TOKYO (AFP) � Japan said Tuesday it plans a nationwide survey to assess the spread of an antibiotic-resistant "superbug" that surfaced in South Asia and was this week confirmed for the first time in Japan.

    The bacterium carrying the New Delhi metallo-lactamase-1 (NDM-1) gene was found in a sample taken from a man in his 50s who was hospitalised with high fever for several months last year after returning from a trip to India.

    Health Minister Akira Nagatsuma said the government may start a survey as early as this week of how far the new type of bug has spread, while also tightening reporting requirements on hospitals.

    Drug-resistance in bacteria, blamed on the excessive and improper use of antibiotics, is not new, but the UN health agency has issued a warning on NDM-1 following research published in The Lancet medical journal last month.

    The World Health Organization (WHO) has called on global health authorities to monitor the new gene that enables some types of micro-organisms to be highly resistant to almost all antibiotics.

    The Lancet said bacteria containing the NDM-1 gene had been found in 37 Britons who had received medical treatment in South Asia.

    Western patients are flocking to India for operations ranging from facelifts to fertility treatment and open-heart surgery that cost in some cases only half of the going rate back home.

    Indian doctors warned earlier this year that patients could spread the bacteria worldwide and cases have been reported in several countries.

    Last month a Belgian became the first known fatality from NDM-1. The unnamed man had been hospitalised in Pakistan for a leg injury from a car accident and died after being repatriated to a hospital in Belgium.

    In Japan, the bug was reported Monday by Dokkyo Medical University Hospital north of Tokyo. Physicians there notified the health ministry after they tested the man's preserved sample following the WHO alert.

     
    "In a time of universal deceit, telling the truth is a revolutionary act."   G Orwell
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mary008 Quote  Post ReplyReply Direct Link To This Post Posted: September 10 2010 at 7:42pm
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    ( hmmm seems bed bugs are rampant )
     
     
     
     
    Hoping to see more Copper in Hospitals...  
     
     
  • Introduction to Antimicrobial Copper

    Copper's antimicrobial properties, exploited since the dawn of civilisation, are now being considered for healthcare, the food processing industry and air ...
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    Pub 182 - Naturally Antimicrobial Alloys for Touch Surfaces

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    The presence and spread of bacterial pathogens in hospitals is a growing ... properties of copper and copper alloys, such as brass and bronze. ... transmission by considering the germ-fighting capabilities of the materials they use. ...
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    Because of the antimicrobial properties it exhibits, copper alloy hardware should be .... New antibiotic for hospital use. premium_logo ... technology has beaten back a virulent strain of bacterial infection that has become a growing ...
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    Copper: essential for life

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    For comprehensive information on copper's antimicrobial properties, including .... frequent use of alcohol-based handrubs by staff in hospitals to control MRSA ... research say about new applica- tions for copper in the healthcare ...
    www.eurocopper.org/files/antimicrobial_cor13.pdf
  • Antimicrobial properties of copper - Wikipedia, the free encyclopedia

    Dollwet, H.H.A. and Sorenson, J.R.J. Historic uses of copper compounds in medicine, ... Rates in Hospitals and Healthcare Facilities - The Role of Copper Alloys in ... 24–27 May 2004, New Orleans; presented at the American Society for ...
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Fisher Quote  Post ReplyReply Direct Link To This Post Posted: September 11 2010 at 6:55am

    excellent thread

    thanks to everyone for the very informative links

    we are going to do ourselves in

    due to our indiscriminate use of antibiotics

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    Post Options Post Options   Thanks (0) Thanks(0)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: September 14 2010 at 11:28am
    New drug-resistant superbugs found in 3 states

    news.yahoo.com...

    An infectious-disease nightmare is unfolding: A new gene that can turn many types of bacteria into superbugs resistant to nearly all antibiotics has sickened people in three states and is 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.
    Long time lurker since day one to Member.
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: September 15 2010 at 8:31am

    Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase — United States, 2010

    During January-June 2010, three Enterobacteriaceae isolates carrying a newly described resistance mechanism, the New Delhi metallo-beta-lactamase (NDM-1) (1), were identified from three U.S. states at the CDC antimicrobial susceptibility laboratory. This is the first report of NDM-1 in the United States, and the first report of metallo-beta-lactamase carriage among Enterobacteriaceae in the United States. These isolates, which include an Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, carry blaNDM-1, which confers resistance to all beta-lactam agents except aztreonam (a monobactam antimicrobial) (1); all three isolates were aztreonam resistant, presumably by a different mechanism. In the United Kingdom, where these organisms are increasingly common, car­riage of Enterobacteriaceae containing blaNDM-1 has been closely linked to receipt of medical care in India and Pakistan (2). All three U.S. isolates were from patients who received recent medical care in India.

    Carbapenem resistance and carbapenemase produc­tion conferred by blaNDM-1 is detected reliably with phenotypic testing methods currently recommended by the Clinical and Laboratory Standards Institute (3), including disk diffusion testing and the modified Hodge test (4). Carbapenem resistance in all three of these isolates was detected in the course of routine testing. Current CDC infection control guidance for carbapenem-resistant Enterobacteriaceae also is appropriate for NDM-1–producing isolates (5). This includes recognizing carbapenem-resistant Enterobacteriaceae when cultured from clinical specimens, placing patients colonized or infected with these isolates in contact precautions, and in some circumstances, conducting point prevalence sur­veys or active-surveillance testing among other high-risk patients. Laboratory identification of the carbapenem- resistance mechanism is not necessary to guide treatment or infection control practices but should instead be used for surveillance and epidemiologic purposes.

     

    Clinicians should be aware of the possibility of NDM-1   producing Enterobacteriaceae in patients who have received medical care in India and Pakistan, and should specifically inquire about this risk fac­tor when carbapenem-resistant Enterobacteriaceae are identified. CDC asks that carbapenem-resistant isolates from patients who have received medical care within 6 months in India or Pakistan be forwarded through state public health laboratories to CDC for further characterization. Infection control interven­tions aimed at preventing transmission, as outlined in current guidance (5), should be implemented when NDM-1–producing isolates are identified, even in areas where other carbapenem-resistance mechanisms are common among Enterobacteriaceae.

     
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: September 15 2010 at 8:32pm
    Originally posted by Mahshadin Mahshadin wrote:

    Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase -- United States, 2010

    During January-June 2010, three Enterobacteriaceae isolates carrying a newly described resistance mechanism, the New Delhi metallo-beta-lactamase (NDM-1) (1), were identified from three U.S. states at the CDC antimicrobial susceptibility laboratory. This is the first report of NDM-1 in the United States, and the first report of metallo-beta-lactamase carriage among Enterobacteriaceae in the United States. These isolates, which include an Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae, carry blaNDM-1, which confers resistance to all beta-lactam agents except aztreonam (a monobactam antimicrobial) (1); all three isolates were aztreonam resistant, presumably by a different mechanism. In the United Kingdom, where these organisms are increasingly common, car­riage of Enterobacteriaceae containing blaNDM-1 has been closely linked to receipt of medical care in India and Pakistan (2). All three U.S. isolates were from patients who received recent medical care in India.

    Carbapenem resistance and carbapenemase produc­tion conferred by blaNDM-1 is detected reliably with phenotypic testing methods currently recommended by the Clinical and Laboratory Standards Institute (3), including disk diffusion testing and the modified Hodge test (4). Carbapenem resistance in all three of these isolates was detected in the course of routine testing. Current CDC infection control guidance for carbapenem-resistant Enterobacteriaceae also is appropriate for NDM-1–producing isolates (5). This includes recognizing carbapenem-resistant Enterobacteriaceae when cultured from clinical specimens, placing patients colonized or infected with these isolates in contact precautions, and in some circumstances, conducting point prevalence sur­veys or active-surveillance testing among other high-risk patients. Laboratory identification of the carbapenem- resistance mechanism is not necessary to guide treatment or infection control practices but should instead be used for surveillance and epidemiologic purposes.

     

    Clinicians should be aware of the possibility of NDM-1   producing Enterobacteriaceae in patients who have received medical care in India and Pakistan, and should specifically inquire about this risk fac­tor when carbapenem-resistant Enterobacteriaceae are identified. CDC asks that carbapenem-resistant isolates from patients who have received medical care within 6 months in India or Pakistan be forwarded through state public health laboratories to CDC for further characterization. Infection control interven­tions aimed at preventing transmission, as outlined in current guidance (5), should be implemented when NDM-1  producing isolates are identified, even in areas where other carbapenem-resistance mechanisms are common among Enterobacteriaceae.

     
     
    "In a time of universal deceit, telling the truth is a revolutionary act."   G Orwell
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: September 16 2010 at 12:49pm

    Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

    Summary

    Background

    Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK.

    Methods

    Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene blaNDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan.

    Findings

    We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries.

    Interpretation

    The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.

    Funding

    European Union, Wellcome Trust, and Wyeth.

    Introduction

    Bacteria from clinical and non-clinical settings are becoming increasingly resistant to conventional antibiotics. 10 years ago, concern centred on Gram-positive bacteria, particularly meticillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus spp. Now, however, clinical microbiologists increasingly agree that multidrug-resistant Gram-negative bacteria pose the greatest risk to public health. Not only is the increase in resistance of Gram-negative bacteria faster than in Gram-positive bacteria,1, 2 but also there are fewer new and developmental antibiotics active against Gram-negative bacteria3—6 and drug development programmes seem insufficient to provide therapeutic cover in 10—20 years.7—9
    The increase in resistance of Gram-negative bacteria is mainly due to mobile genes on plasmids that can readily spread through bacterial populations. Standardised plasmid typing methods are enhancing our understanding of the host ranges of these elements and their worldwide distribution.10, 11 Moreover, unprecedented human air travel and migration allow bacterial plasmids and clones to be transported rapidly between countries and continents.12, 13 Much of this dissemination is undetected, with resistant clones carried in the normal human flora and only becoming evident when they are the source of endogenous infections. The CTX-M-15 extended-spectrum β-lactamase (ESBL) encoded by blaCTX-M-15 was first reported in India in the mid-1990s.14, 15 The gene jumped from the chromosome of its natural hosts, Kluyvera spp, to plasmids that have subsequently spread widely,10, 16 establishing CTX-M-15 as the globally-dominant ESBL and the primary cause of acquired resistance to third-generation cephalosporins in Enterobacteriaceae.17, 18
    Recent surveys have identified ESBLs in 70—90% of Enterobacteriaceae in India and; although these collections might be a biased sample, they do suggest a serious problem, making the widespread use of reserved antibiotics such as carbapenems necessary.15, 19 Rates of cephalosporin resistance are lower in other countries but the growing prevalence of ESBL producers is sufficient to drive a greater reliance on carbapenems. Consequently, there is selection pressure for carbapenem resistance in Enterobacteriaceae, and its emergence is a worldwide public health concern since there are few antibiotics in reserve beyond carbapenems.20 Already Klebsiella pneumoniae clones with KPC carbapenemase are a major problem in the USA, Greece, and Israel, and plasmids encoding the VIM metallo-carbapenemase have disseminated among K pneumoniae in Greece.21
    We recently reported a new type of carbapenem resistance gene, designated blaNDM-1.22 A patient, repatriated to Sweden after admission to hospital in New Delhi, India, was colonised by K pneumoniae and Escherichia coli with blaNDM-1 on plasmids of varying size, which readily transferred between bacterial strains in vitro. We sought molecular, biological, and epidemiological data on New Delhi metallo-β-lactamase 1 (NDM-1) positive Enterobacteriaceae in India and Pakistan and investigated importation of the resistance gene into the UK by patients returning from the Indian subcontinent.

    Methods

    Bacterial isolates

    Isolates of bacteria were identified from Chennai and Haryana in India. UK isolates were identified from referrals to the Antibiotic Resistance Monitoring and Reference Laboratory by UK microbiology laboratories between 2003 and 2009. We also identified isolates from other sites around Bangladesh, India, and Pakistan.

    Procedures

    Bacteria were identified via the Phoenix automated phenotypic identification criteria (Becton Dickinson, Oxford, UK) or with API 20E strips (bioMerieux, Basingstoke, UK). Minimum inhibitory concentrations (MICs) and carbapenem resistance were established by microbroth dilution (Phoenix), British Society for Antimicrobial Chemotherapy (BSAC) agar dilution, or disc diffusion.
    Modified Hodge (cloverleaf) test involving distorted carbapenem inhibition zones and imipenem-EDTA synergy tests by disc, or the MBL Etest (AB bioMerieux, Solna, Sweden) were used to screen for metallo-β-lactamase production.23 The presence of blaNDM-1 was established by PCR with specific primers targeting the gene.22 PCR and sequencing were used to identify other resistant genes (blaCMY-4 and blaCTX-M-15) carried by the bacterial isolates.
    Conjugational transfer of antibiotic resistance to the laboratory strain E coli J53 was done on blood agar without selection. After 18 h, the mixed cultures were washed from the plates, suspended in saline, and plated onto MacConkey agar containing sodium azide (100 mg/L) and meropenem (2 mg/L). Transconjugants were confirmed to have blaNDM-1 by PCR analysis. Plasmids were subsequently isolated and typed on the basis of their origins of replication, as described by Carattoli and colleagues.11
    Genomic DNA was prepared in agarose blocks and digested with the restriction enzyme XbaI (Roche Diagnostics, Mannheim, Germany). DNA fragments were separated by pulsed-field gel electrophoresis (PFGE) on a CHEF-DR III apparatus (Bio-Rad, Hercules, CA, USA) for 20 h at 6 V/cm at 14°C with an initial pulse time of 0·5 s and a final pulse time of 30 s. Dendrograms of strain relatedness were created with BioNumerics software.
    Genomic DNA in agarose blocks was digested with the restriction enzyme S1 (Invitrogen, Abingdon, UK). DNA fragments were separated by PFGE as above. In-gel hybridisation was done with a blaNDM-1 probe labelled with 32P (Stratgene, Amsterdam, Netherlands) with a random-primer method.22 Plasmid DNA bands that hybridised with blaNDM-1 were cut from the gel, purified, and typed as described by Carattoli and colleauges.11

    Role of the funding source

    The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

    Results

    From Chennai, 75 E coli, 60 Klebsiella spp, and six other Enterobacteriaceae resistant to carbapenems were isolated from 3521 (4%) Enterobacteriaceae analysed throughout 2009. Of these 141 carbapenem-resistant Enterobacteriaceae, 44 (19 E coli, 14 K pneumoniae, seven Enterobacter cloacae, two Proteus spp, one Citrobacter freundii, and one Klebsiella oxytoca) were NDM-1 positive (about 1% of all resistant isolates). During that same period, 47 carbapenem-resistant isolates (24%) of 198 from Haryana were identified; from these, 26 (13%) were positive for NDM-1, and all were K pneumoniae. The Indian isolates from Chennai and Haryana were primarily from community acquired urinary tract infections, pneumonia, and blood-stream infections. The age range was 4—66 years with a mean of 36 years (SD 20) and a female to male ratio of about two to one.
    In the UK resistant isolates increased in both 2008 and 2009 (figure 1). Isolates with the NDM-1 enzyme, which was first detected in the UK in 2008, became the predominant carbapenemase-producing Enterobacteriaceae in 2009, accounting for 32 (44%) of 73 carbapenemase producers. During 2008—09, 37 Enterobacteriaceae isolates with the NDM-1 enzyme were referred from 25 laboratories across England with single representatives also from Scotland and Northern Ireland. These were identified as K pneumoniae (21 isolates), E coli (seven), Enterobacter spp (five), Citrobacter freundii (two), Morganella morganii (one), and Providencia spp (one). They were from 29 patients and had been isolated from urine (15 patients), blood (three), burn or wound swab (four), sputum (two), central line tip (one), throat swab (one), or unknown specimens (three). The mean age of the patients was 60 years (SD 24; range 1—87), with 17 male patients and 12 female patients. At least 17 patients had a history of travelling to India or Pakistan within 1 year, and 14 of them had been admitted to a hospital in these countries. Reasons for these admissions included renal or bone marrow transplantation, dialysis, cerebral infarction, chronic obstructive pulmonary disease, pregnancy, burns, road traffic accidents, and cosmetic surgery.
    document.write('
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    Numbers of carbapenemase-producing Enterobacteriaceae referred from UK laboratories to the UK Health Protection Agency's national reference laboratory from 2003 to 2009
    The predominant gene is blaNDM-1, which was first identified in 2008. The other group includes diverse producers of KPC, OXA-48, IMP, and VIM enzymes.
    Isolates, NDM-1-positive bacteria from Mumbai (32 isolates), Varanasi (13), and Guwahati (three) in India, and 25 isolates from eight cities in Pakistan (Charsadda, Faisalabad, Gujrat, Hafizabad, Karachi, Lahore, Rahim Yar Khan, and Sheikhupura) were also analysed in exactly the same manner but in laboratories in India and Pakistan. These isolates were from a range of infections including bacteraemia, ventilator-associated pneumonia, and community-acquired urinary tract infections.
    All the isolates producing the NDM-1 enzyme were resistant to several antibiotic classes (table). The 37 UK isolates were all resistant to imipenem and ertapenem, although a single M morganii isolate remained susceptible, at least in vitro, to meropenem (MIC 2 mg/L). Only four UK isolates remained susceptible to the monobactam aztreonam (MICs ≤1 mg/L), which is unaffected by metallo-carbapenemases including NDM-1; the other UK isolates were all resistant to all β-lactams, including aztreonam, suggesting the concurrent presence of additional β-lactamases including ESBLs and AmpC enzymes—identified by sequencing as mainly blaCTX-M-15 and blaCMY-4. All 37 isolates were resistant to amikacin and tobramycin, although one isolate was susceptible to gentamicin and three to ciprofloxacin. MICs of minocycline were consistently 2 mg/L or greater, interpreted as non-susceptible with the BSAC and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints for doxycycline, but most (33 of 37) were susceptible to colistin (MICs ≤4 mg/L) and 26 were suseptible to tigecycline (MICs ≤1 mg/L; figure 2).
    Click%20to%20open%20table
    Antibiotic susceptibilities for NDM-1-positive Enterobacteriaceae isolated in the UK and north (Chennai) and south India (Haryana)
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    90% minimum inhibitory concentration (MIC90) for Enterobacteriaceae from Chennai and Haryana, India, and the UK
    The 44 isolates from Chennai were similarly resistant to all β-lactam antibiotics, fluoroquinolones, and aminoglycosides, apart from two that were sensitive to gentamicin. 39 were resistant to minocycline with MICs >2 mg/L, 19 to tigecycline, and three to colistin (table and figure 2). Two of the three isolates resistant to colistin were Proteus spp, which are intrinsically resistant, and the third was a K pneumoniae strain (colistin MIC >32 mg/L; tigecycline MIC 8 mg/L). Although several reports from Greece have noted K pneumoniae isolates as colistin resistant, we believe our isolate is truly pan-resistant.24, 25 Most of the 26 Haryana isolates were resistant to all β-lactam and non-β-lactam antibiotics, although three were susceptible to aztreonam and one to ciprofloxacin and amikacin. Minocycline MICs for the Haryana isolates were 8—16 mg/L and ten isolates had intermediate resistance (2 mg/L) to tigecycline by EUCAST criteria. None were resistant to colistin (table and figure 2).
    The 21 Klebsiella isolates from the UK had different PFGE profiles and were typed to 19 distinct groups with only two related pairs, both of which included isolates from epidemiologically linked patients, probably representing cases of cross-infection. All the UK E coli isolates were different. The Chennai isolates were also very different, with none similar to each other. By contrast, the 26 NDM-positive K pneumoniae isolates from Haryana belonged to a single PFGE profile suggesting clonal spread. We could not prove statistically significant strain relatedness between the Indian and UK isolates.
    Isolates from Chennai, Haryana, and the UK's Antibiotic Resistance Monitoring and Reference Laboratory were analysed for the location of the blaNDM-1 gene by S1 digestion of DNA, and then PFGE and direct probing of the gels with a radiolabelled blaNDM-1 gene. Each of the three groups of isolates typically carried several plasmids, with some isolates having up to eight plasmids (figure 3).
    document.write
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    The difference in plasmid numbers from a selection of Indian isolates
    Tracks 1—10 show the number of plasmids in isolates from Chennai (south India) and tracks 11—18 show the number of plasmids in isolates from Haryana (north India). Most isolates contained up to seven plasmids, and in Chennai there was greater variation than in isolates from Haryana showing the bacterial clonality of NDM-1 carriage in Haryana.
    Indian isolates had blaNDM-1 exclusively on plasmids. Plasmids from the non-clonal Chennai isolates ranged from 50 kb to 350 kb, whereas those from the clonal K pneumoniae from Haryana were predominately either 118 kb (54%) or 50 kb (36%). The UK isolates had a more diverse range of plasmid sizes, 80 kb to greater than 500 kb. Three UK isolates also carried blaNDM-1 on their chromosome, suggesting in-situ movement of blaNDM-1. There were many plasmids of identical size in isolates collected from India and the UK (data not shown), suggesting plasmid movement between bacterial isolates. In some isolates, blaNDM-1 was carried on more than one plasmid (figure 4).
    document.write
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    Hybridisation results of UK isolates with blaNDM-1
    Pulsed-field gel of S1-treated plasmid DNA of UK isolates M15—M27 stained with ethidium bromide (A). Molecular weight marker is Lambda concatamer 50—1000 kb. The chromosome of each isolate is the bright band at the top of each lane and bright bands below are plasmids of various sizes. Autoradiogram of gel A probed with a blaNDM-1 showing individual or multiple plasmids in each strain carrying blaNDM-1 (B).
    47 isolates from Chennai (33) and Haryana (14) were randomly chosen for further investigation with PCR and DNA probing to verify the origin of replication (incompatibility type) for plasmids carrying blaNDM-1.11, 22 Plasmids carrying blaNDM-1 from the 14 isolates from Haryana could not be typed. 13 of the 33 isolates from Chennai carried blaNDM-1 on A/C-type plasmids and one blaNDM-1 positive plasmid was incompatibility type FI/FII. Similarly, when the 32 randomly selected UK isolates were assessed with the same methods, 22 carried A/C type plasmids. The other blaNDM-1 positive plasmids from India and the UK that were A/C and FI/FII negative could not be typed.
    Transconjugants were created in E coli J53 from the 33 Chennai and 32 UK isolates; however, the isolates from Haryana did not produce transconjugates.22 All transconjugants were shown by PCR to contain blaNDM-1. We compared the sizes of the plasmids in the clinical strains with those of the transconjugants and, in about 10% of cases, the plasmid had altered in size during transfer. In most cases the plasmid had lost DNA but two of 102 had gained DNA during transfer.
    In addition to the collections of isolates from Chennai and Haryana detailed above, we have confirmed by PCR alone the presence of genes encoding NDM-1 in carbapenem-resistant Enterobacteriaceae isolated from Guwahati, Mumbai, Varanasi, Bangalore, Pune, Kolkata, Hyderabad, Port Blair, and Delhi in India, eight cities (Charsadda, Faisalabad, Gujrat, Hafizabad, Karachi, Lahore, Rahim Yar Khan, and Sheikhupura) in Pakistan, and Dhaka in Bangladesh (figure 5) suggesting widespread dissemination.
    document.write
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    Distribution of NDM-1-producing Enterobacteriaceae strains in Bangladesh, Indian, Pakistan, and the UK

    Discussion

    Enterobacteriaceae with NDM-1 carbapenemases are highly resistant to many antibiotic classes and potentially herald the end of treatment with β-lactams, fluoroquinolones, and aminoglycosides—the main antibiotic classes for the treatment of Gram-negative infections. Only a few isolates remained sensitive to individual aminoglycosides and aztreonam, perhaps owing to the loss of resistance genes (eg, those encoding aminoglycoside modifying enzymes, 16S rRNA methylases, or blaCMY-4).12, 22 Most isolates remained susceptible to colistin and tigecycline.
    Typing did not identify common strain types of E coli or K pneumoniae between the Indian subcontinent and the UK or between north and south India. Nevertheless, the NDM-1-positive K pneumoniae isolates from Haryana were clonal, suggesting that some strains could potentially cause outbreaks. Most blaNDM-1 positive plasmids were readily transferable and prone to rearrangement, losing or (more rarely) gaining DNA on transfer. This transmissibility and plasticity implies an alarming potential to spread and diversify among bacterial populations. Curiously, many of the plasmids were incompatibility A/C types—a group not commonly associated with multidrug-resistant phenotypes.
    Although antibiotic resistance in China has been highlighted as a concern,4 the rapid emergence of blaNDM-1 deserves equal attention. A recent editorial by Abdul Ghafur26 highlights the widespread non-prescription use of antibiotics in India, leading to huge selection pressure, and predicts that the NDM-1 problem is likely to get substantially worse in the foreseeable future. This scenario is of great concern because there are few new anti-Gram-negative antibiotics in the pharmaceutical pipeline and none that are active against NDM-1 producers.20 Even more disturbing is that most of the Indian isolates from Chennai and Haryana were from community-acquired infections, suggesting that blaNDM-1 is widespread in the environment.27
    The introduction of NDM-1 into the UK is also very worrying and has prompted the release of a National Resistance Alert 3 notice by the Department of Health on the advice of the Health Protection Agency.28 Given the historical links between India and the UK, that the UK is the first western country to register the widespread presence of NDM-1-positive bacteria is unsurprising. However, it is not the only country affected. In addition to the first isolate from Sweden, a NDM-1-positive K pneumoniae isolate was recovered from a patient who was an Australian resident of Indian origin and had visited Punjab in late 2009. The isolate was highly resistant and carried blaNDM-1 on an incompatibility A/C type plasmid similar to those in India and the UK.
    Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and blaNDM-1 will likely spread worldwide. It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money.29 As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals. The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide, are clear and frightening.
     
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote haney Quote  Post ReplyReply Direct Link To This Post Posted: September 19 2010 at 10:24pm

    People in Massachusetts, California and Illinois have shown up with NDM-1 which is a superbug that a British health related journal talked about last month. Many assume the bug originated from India while all three cases were of patients who had recently been to India. I found this here: Superbug from India on worldwide tour arrives to infect the U.S. NDM-1 was blamed on medical tourism at first. This is because many British citizens were going to India for low-cost cosmetic surgery and returning home with the disease. But the truth that the American superbug victims weren't medical tourists is leading scientists to believe that the potential of NDM-1 as a worldwide threat is more serious than first thought.
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mahshadin Quote  Post ReplyReply Direct Link To This Post Posted: October 08 2010 at 10:55am

    Mass. hunting for deadly NDM-1 cousin

    Published: Oct. 7, 2010 at 6:33 PM
     
    BOSTON, Oct. 7 (UPI) -- Massachusetts hospitals will be surveyed to find out how many cases of a genetic cousin of a drug-resistant "superbug" are being treated, state officials said.

    The survey, conducted by the Massachusetts Department of Public Health, will seek to gauge the incidence of Klebsiella pneumoniae, a deadly, drug-resistant bacterium that has been detected in 35 U.S. states, The Boston Globe reported.

    The rod-shaped Klebsiella bacterium is related to NDM-1, or New Delhi metallo-beta-lactamase, first identified in December 2009 in a patient hospitalized in New Delhi. The NDM-1 enzyme, which lets bacteria escape some of the strongest antibiotics, was later detected in bacteria in Pakistan, Britain, Belgium, the United States, Canada, Australia, Japan and Taiwan.

    Like NDM-1, Klebsiella is highly resistant to some of the strongest antibiotics available, leaving doctors with few options when patients develop urinary tract, bloodstream or respiratory infections, the Globe reported.

    "They're both really bad, and you don't want to get (them)," Dr. Helen Boucher, an infectious disease specialist at Tufts Medical Center, told the Globe.

    But if Klebsiella remains in the intestinal tract, where it is naturally found, it typically causes no problems, doctors say.

    Its problems typically come about if it finds a way to escape the intestines, such as during surgery or some other medical treatment that causes incisions or requires invasive medical equipment to provide or remove fluids or sustain breathing, doctors say.

    One of the two drugs doctors can use to combat Klebsiella is colistin -- but it was largely abandoned years ago because it was shown to be highly toxic to the kidneys and the nerves.

    But, as a last resort, "if the person is really sick and they're not doing well, we end up having to do the colistin routine," Boucher told the Globe, "and we hold our breath."

     
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    Mary008 View Drop Down
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Mary008 Quote  Post ReplyReply Direct Link To This Post Posted: October 22 2010 at 11:27am
     
     
     
     
     
     
     
     
     
    ...But if Klebsiella remains in the intestinal tract, where it is naturally found,
     
    it typically causes no problems, doctors say.
     
     
     
     ...it finds a way to escape the intestines, such as during surgery or some other medical
     
    treatment that causes incisions or requires invasive medical equipment to provide or
     
    remove fluids or sustain breathing, doctors say.
     
     
     
     
    They should more acurately quote The Boston Globe-
     
     
    ...But its genetic cousin has been spreading for several years in US hospitals
     
     
    .............................
     
     
    Mary008
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    Kilt2 View Drop Down
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Kilt2 Quote  Post ReplyReply Direct Link To This Post Posted: October 30 2010 at 10:05pm
    super bug are no problem

    or they wouldnt be if they listened to me - but the health authorities are basicly stupid and cant use their brains.

    I have the answer.

    Will anyone listen?

    Nooooooooooooooo
    And I looked, and behold a pale horse: and his name that sat on him was Death, and Hell followed with him.
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