Some 77 cases of a multi-drug resistant "superbug" from India first reported in Britain in August have now been detected in 13 European countries, a scientist at the EU's disease watchdog said on November 17.
Dominique Monnet of the European Centre for Disease Prevention and Control (ECDC) said he was very worried by the emergence of NDM-1, or New Delhi metallo-beta-lactamase, and other bugs like it that are resistant to even the most powerful class of antibiotics, known as carbapenems.
"I know people are calling this NDM-1 a superbug, but for me NDM-1 and bacteria like it are more than superbugs. We're talking about super superbugs," Monnet said in a telephone interview from Stockholm, where the ECDC is based.
"For a long time doctors in hospitals, especially in intensive care units, have relied on the carbapenems as the last line of antibiotic treatment. Now, for doctors facing a patient infected with a bacteria that is resistant to carbapenems, the options for treatment are limited." NDM-1 is a gene carried by bacteria that alters them and makes then resistant to almost all known antibiotics. It can manifest itself in many different ways and is often found in bacteria like Klebsiella pneumonia and E-coli, both of which can cause urinary tract infections and pneumonia.
British researchers reported in August that cases of infection with NDM-1 bugs had been found in patients in South Asia and in Britain and said they feared it could spread around the world, in part because of medical tourism.
US health officials said at the same time that three cases had been detected in the United States. Monnet is due to publish a paper this week in online journal Eurosurveillance which shows how the bug is spreading in Europe.
In a separate briefing for reporters, Monnet said a total of 77 NDM-1 cases had now been detected in 13 European countries, including Britain, France, Germany, Spain, Italy and others, between 2008 and 2010.
Around two-thirds of the cases were in Britain, he said, and data showed that seven of the infected patients had died. "Most cases were associated with healthcare in or travel to the Indian subcontinent," he said, a finding that confirmed what the British study also showed - that increasing international travel and medical tourism, where patients go abroad for treatment, are helping to spread superbugs around the world.
Monnet added that a small proportion of the NDM-1 cases were found in patients who had received healthcare in the Balkans. Almost as soon as penicillin, the world's first antibiotic, was introduced in the 1940s, bacteria began to develop resistance to its effects, prompting scientists and drug firms to work on developing many new generations of antibiotics.
Experts say their constant overuse and misuse have fuelled the rise of drug-resistant superbugs such as Clostridium difficile, or methicillin-resistant Staphyloccus aureus (MRSA).
Now carbapenems - a class of the drugs traditionally reserved for last-line use and to treat infections caused by the likes of MRSA and C-difficile - are also becoming powerless in the face of ever more ingenious bacteria. "Doctors have relied very much on the availability of new antibiotics," Monnet said. "They have always had this kind of forward escape strategy of counting on the pharmaceutical industry to produce new antibiotics that will help counteract the emergence of resistance."
"But what we have now is increasing multidrug resistant bacteria in the EU and at the same time a rather dry pipeline for new antibiotics. We are running out of antibiotics." A few large drugmakers, including Pfizer, Merck, AstraZeneca, GlaxoSmithKline and Novartis, are hunting for new antibiotics but the scientific difficulty and expense of finding effective treatments is stacked against the limited sales potential of drugs that are typically reserved for the sickest patients. Experts cite only two drugs that can stand up to carbapenem-resistant infections.
One is colistin, an older antibiotic which Monnet said has such toxic side effects that it would probably not be approved for a licence under today's drug regulation standards. The other is Pfizer's antibiotic Tygacil, known generically as tigecycline, which Monnet said only works in some cases.
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