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Q&A: NDM-1 superbugs By Michelle Roberts Health reporter, BBC News NDM-1 is carried by Gram-negative bacteria like Klebsiella Experts have warned that a new type of drug-resistant superbug is emerging in UK hospitals. Q: What is NDM-1? New Delhi metallo-ß-lactamase-1, or NDM-1 for short, is a gene carried by bacteria that makes the strain resistant to carbapenem antibiotics. This is concerning because these antibiotics are some of the most powerful ones, used on hard-to-treat infections that evade other drugs. Q: Why is this a problem? NDM-1 (or more precisely the DNA code for this enzyme) can easily now jump from one strain of bacteria to another. Experts are worried that it may end up in another bacterium which is already resistant to many other antibiotics. Ultimately, it could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat. Q: Can it be treated? Other treatment options are available to fight these infections but they present major challenges for clinicians and will often demand combinations of antibiotics are used. Scientists have identified some strains that have been resistant to all known antibiotics. Q: How would I know if I had it? So far, many of the UK cases have been in patients who have recently travelled to India or Pakistan for medical treatment and who caught the infection while there. But, some of these patients have passed the infection on to others in UK hospitals upon their return. The infections have ranged from mild to severe - and some have been fatal. Two types of bacteria have been host to NDM-1: the gut bacterium E.coli and another that can invade the lungs called Klebsiella pneumonia. Both can lead to urinary tract infections and blood poisoning. Infections such as these would usually be spotted in patients by medics. Q: Can its spread be stopped? Experts say the way to stop it is through surveillance, rapid identification and isolation of any hospital patients who are infected. Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread. NDM-1 is already widespread in the Indian subcontinent and has also reached countries including the US, Canada, Australia and the Netherlands. Scientists believe it has the potential to become a global public health issue. And they say we now need new drugs to treat resistant strains. Q: Are there new antibiotics that could help? While there is a great deal of investment in research to find new antibiotics, experts say that most of the drugs currently in the pipeline will be useless for treating NDM-1 positive patients. This is because the bacteria that carry NDM-1 are Gram-negative, while most of the work is being carried out for Gram-positive bugs like MRSA. The Health Protection Agency says "multi-resistant Gram-negative bacteria pose a notable public health risk and it remains important that the pharmaceutical industry continues to work towards developing new treatment options". The Department of Health said it was investigating ways of encouraging the development of new antibiotics with European colleagues. Q: What will happen now? The government said HPA would continue to monitor the situation and would regularly review the data and the need for further action. In the meantime, hospitals should ensure they continue to provide good infection control to prevent any spread, and consider whether patients have recently been treated abroad and send samples to HPA for testing if necessary. | 
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