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Epidemiological update on new metallo-β-lactamase ?superbug? threat (ECDC, 8/17/10, edited)
Epidemiological update on NDM-1 ?superbug? threat (ECDC, 8/17/10, edited)
[Source: ECDC, full text (LINK). Edited.]
Epidemiological update on NDM-1 ?superbug? threat
17 Aug 2010
International spread of extensively antibiotic-resistant carbapenemase-producing Enterobacteriaceae: new variant called NDM-1 (New Delhi metallo-β-lactamase) detected in Europe.
Epidemiological surveillance data from Europe (EARS-Net) and other parts of the world indicate that antibiotic resistance is increasing in Enterobacteriaceae bacteria, such as Escherichia coli and Klebsiella pneumoniae. These bacteria, which are part of the normal human gut flora, are also commonly causing infections such as urinary tract infections, bloodstream infection or healthcare-associated infections.
Resistance to penicillins and cephalosporins caused by extended-spectrum beta-lactamases, for instance, are increasing in frequency in Enterobacteriaceae. This situation makes the use of last resort intravenous antibiotics like carbapenems more frequently necessary. Carbapenems, however, can no longer be used when these bacteria also become carbapenem-resistant by acquisition of new genes for carbapenemase enzymes.
For over a decade, different types of carbapenemases, including metallo-β-lactamases and KPC-type β-lactamases, have been found in Enterobacteriaceae and other bacteria. These extensively antibiotic-resistant Enterobacteriaceae still remain relatively uncommon cause of human infection in Europe. However, some carbapenemase-producing strains of K. pneumoniae have caused outbreaks of infection in several countries in Europe and elsewhere. These epidemic bacteria spread across borders when carried by patients transferred between hospitals from different countries.
Recent publications have described cases in Europe of human infections by New Delhi metallo-β-lactamase 1 (NDM-1). This new enzyme was first detected in 2008 in E. coli and K. pneumoniae isolates from a patient repatriated to Sweden after being treated in a hospital in New-Delhi, India, hence its name. Whereas these organisms are increasingly common in the United Kingdom (UK), they have also been reported from India, Pakistan, Bangladesh, Australia, the United States, Canada, Germany, the Netherlands and Belgium. The latter case was reported to be a fatal leg wound infection in a patient repatriated from Pakistan after trauma care.
A recently published study of a large set of bacterial isolates from cases of infection or colonisation in the UK and the Indian subcontinent, showed that NDM-1-producing bacteria are extensively antibiotic-resistant, like other carbapenemase- producing Enterobacteriaceae described previously. The majority of these NDM-1-producing bacteria were usually still susceptible to two antibiotics: colistin and, less consistently, tigecycline. The NDM-1 enzyme was genetically encoded on plasmids, which are small elements that can pass on from one bacterium to another. This feature may facilitate its rapid diffusion in human populations.
Among British NDM-1 cases, the majority had a history of travelling to India or Pakistan within the past year. Many had been admitted to a hospital in these countries for various medical reasons, including elective surgery and emergency care. Thus, these cases reflect the well-known risk associated with exposure to health care in countries where multiple antibiotic-resistant bacteria are more common.
ECDC is aware of the health threat posed by carbapenemase-producing bacteria in general and NDM-1 in particular. It is monitoring the situation closely in cooperation with national public health institutes across Europe. It has initiated a risk assessment on the spread of carbapenemase-producing Enterobacteriaceae (including KPC-, NDM-1- and other metallo-β-lactamase-producing strains) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer. This risk assessment should be completed by the end of 2010. It will ascertain the available evidence on risk factors for acquisition of carbapenemase-producing Enterobacteriaceae and the effectiveness of currently advocated infections control measures, including microbiological screening for patients colonised with these organisms and application of isolation precautions to colonised patients for stopping person to person spread within hospitals.
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[Source: ECDC, full text (LINK). Edited.]
Epidemiological update on NDM-1 ?superbug? threat
17 Aug 2010
International spread of extensively antibiotic-resistant carbapenemase-producing Enterobacteriaceae: new variant called NDM-1 (New Delhi metallo-β-lactamase) detected in Europe.
Epidemiological surveillance data from Europe (EARS-Net) and other parts of the world indicate that antibiotic resistance is increasing in Enterobacteriaceae bacteria, such as Escherichia coli and Klebsiella pneumoniae. These bacteria, which are part of the normal human gut flora, are also commonly causing infections such as urinary tract infections, bloodstream infection or healthcare-associated infections.
Resistance to penicillins and cephalosporins caused by extended-spectrum beta-lactamases, for instance, are increasing in frequency in Enterobacteriaceae. This situation makes the use of last resort intravenous antibiotics like carbapenems more frequently necessary. Carbapenems, however, can no longer be used when these bacteria also become carbapenem-resistant by acquisition of new genes for carbapenemase enzymes.
For over a decade, different types of carbapenemases, including metallo-β-lactamases and KPC-type β-lactamases, have been found in Enterobacteriaceae and other bacteria. These extensively antibiotic-resistant Enterobacteriaceae still remain relatively uncommon cause of human infection in Europe. However, some carbapenemase-producing strains of K. pneumoniae have caused outbreaks of infection in several countries in Europe and elsewhere. These epidemic bacteria spread across borders when carried by patients transferred between hospitals from different countries.
Recent publications have described cases in Europe of human infections by New Delhi metallo-β-lactamase 1 (NDM-1). This new enzyme was first detected in 2008 in E. coli and K. pneumoniae isolates from a patient repatriated to Sweden after being treated in a hospital in New-Delhi, India, hence its name. Whereas these organisms are increasingly common in the United Kingdom (UK), they have also been reported from India, Pakistan, Bangladesh, Australia, the United States, Canada, Germany, the Netherlands and Belgium. The latter case was reported to be a fatal leg wound infection in a patient repatriated from Pakistan after trauma care.
A recently published study of a large set of bacterial isolates from cases of infection or colonisation in the UK and the Indian subcontinent, showed that NDM-1-producing bacteria are extensively antibiotic-resistant, like other carbapenemase- producing Enterobacteriaceae described previously. The majority of these NDM-1-producing bacteria were usually still susceptible to two antibiotics: colistin and, less consistently, tigecycline. The NDM-1 enzyme was genetically encoded on plasmids, which are small elements that can pass on from one bacterium to another. This feature may facilitate its rapid diffusion in human populations.
Among British NDM-1 cases, the majority had a history of travelling to India or Pakistan within the past year. Many had been admitted to a hospital in these countries for various medical reasons, including elective surgery and emergency care. Thus, these cases reflect the well-known risk associated with exposure to health care in countries where multiple antibiotic-resistant bacteria are more common.
ECDC is aware of the health threat posed by carbapenemase-producing bacteria in general and NDM-1 in particular. It is monitoring the situation closely in cooperation with national public health institutes across Europe. It has initiated a risk assessment on the spread of carbapenemase-producing Enterobacteriaceae (including KPC-, NDM-1- and other metallo-β-lactamase-producing strains) through patient transfer between healthcare facilities, with special emphasis on cross-border transfer. This risk assessment should be completed by the end of 2010. It will ascertain the available evidence on risk factors for acquisition of carbapenemase-producing Enterobacteriaceae and the effectiveness of currently advocated infections control measures, including microbiological screening for patients colonised with these organisms and application of isolation precautions to colonised patients for stopping person to person spread within hospitals.
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