Healthcare

Did you know...

The NDM-1 gene produces an enzyme that makes many antibiotics ineffective. However, with proper hand hygiene and disinfection procedures, the spread of NDM-1 infiltrated bacteria can be reduced.¹

About NDM-1

New Delhi metallo-beta-lactamase-1 (NDM-1) is a newly identified gene. This gene is known to affect Gram-negative bacteria of the Enterobacteriaceae species, particularly Escherichia coli and Klebsiella pneumonia. Enterobacteriaceae exposure can lead to serious infections of the urinary tract, chest or blood stream and can even be fatal. Health concerns grow worldwide because the NDM-1 gene is found on DNA structures known as plasmids, which can easily be duplicated and transmitted to other types of bacteria.²

Upon introduction into bacteria, NDM-1 releases an enzyme that blocks almost all antibiotic activity – including the powerful class of antibiotics called carbapenems that are typically used as a last resort for bacterial infections caused by E. coli, K. pneumonia and other multi-drug resistant bacteria. Most NDM-1 mutated bacteria are highly resistant to β-lactam, fluoroquinolone and aminoglycoside antibiotics but remain susceptible to colistin and tigecycline antibiotics.³

How is it transmitted?

NDM-1 infiltrated bacterial infections were first recognized in India, and are slowly spreading across the globe as people travel internationally. They can be transmitted from person to person through food preparation, bodily contact and especially hospital procedures (healthcare associated infections).⁴

What are the symptoms for E.coli and K. pneumoniae?

• E.coli symptoms: diarrhea (usually associated with pain and cramping in the abdomen), nausea and vomiting, and urinary tract infection
• K.pneumonia symptoms: fever (can be accompanied by dizziness and chills), cough (usually present with sputum), upper respiratory tract infection, congestion, wheezing, nausea and vomiting

How can NDM-1 infections be prevented?

Prevention of NDM-1 infiltrated bacterial infections depends largely on the work of public health agencies, doctors and nurses, food production facilities, and hospitals. The current CDC infection control guidance for carbapenem-resistant Enterobacteriaceae is also appropriate for NDM-1 producing isolates.⁵ This guidance indicates that acute care facilities should implement contact precautions for colonized or infected patients.⁶

Some of the steps that can be taken to prevent the spread of infection include:

• Adequate surveillance to detect, track and treat infections promptly
• Appropriate use of antibiotics
• Appropriate and meticulous infection control in healthcare facilities such as proper instrument and hard-surface disinfection, and a strict adherence to hand hygiene

What should be used for environmental disinfection?

There is good news! Doctors say, "There isn't anything the public at large needs to worry about. Antibiotic resistance doesn’t mean the superbugs are indestructible, and the bacteria continue to be killed by standard disinfectants."² The CDC has indicated that "...no data are available that show that antibiotic-resistant bacteria are less sensitive to the liquid chemical germicides than antibiotic-sensitive bacteria..."⁷ This means that to combat antibiotic resistant microorganisms, such as those infiltrated with the NDM-1 gene, you can confidently implement effective routine environmental disinfection procedures utilizing EPA-registered disinfectants.

Sources:

1. New ‘superbug’ found in UK hospitals. Web reference: http://www.bbc.co.uk/news/health-10925411. Accessed 9/9/10.
2. New superbugs emerge in U.K, Asia. Web reference: http://www.cbc.ca/health/story/2010/08/11/uk-lancet-new-superbug.html. Accessed 9/9/10.
3. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Web reference: www.thelancet.com/infection. Accessed 9/9/10.
4. What is the NDM-1 Superbug? Drug-Resistant Health Threat Explained. Web reference: http://www.aolnews.com/surge-desk/article/ndm-1-superbug-a-primer-on-the-drug-resistant-health-threat/19589247. Accessed 9/9/10.
5. Detection of Enterobacteriaceae Isolates Carrying Metallo-Beta-Lactamase- United States, 2010. MMWR, June 25, 2010, 59(24); 750. http://www.cdc.gov/mmwr/pdf/wk/mm5924.pdf. Accessed 10/15/2010.
6. Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities, MMWR, March 20, 2009 / 58(10);256-260 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5810a4.htm. Accessed 10/15/2010.
7. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 http://www.cdc.gov/hicpac/Disinfection_Sterilization/3_3inactivBioAgents.html. Accessed 10/15/2010.