From the NYTimes, “Antibiotic-Resistant Bacteria Moving From South Asia to U.S.“:
A dangerous new mutation that makes some bacteria resistant to almost all antibiotics has become increasingly common in India and Pakistan and is being found in patients in Britain and the United States who got medical care in those countries, according to new studies.
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Experts in antibiotic resistance called the gene mutation, named NDM-1, “worrying” and “ominous,” and they said they feared it would spread globally.
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Bacteria with the NDM-1 gene are resistant even to the antibiotics called carbapenems, used as a last resort when common antibiotics have failed. The mutation has been found in E. coli and in Klebsiella pneumoniae, a frequent culprit in respiratory and urinary infections…
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In June, the Centers for Disease Control and Prevention noted the first three cases of NDM-1 resistance in this country and advised doctors to watch for it in patients who had received medical care in South Asia. The initials stand for New Delhi metallo-beta-lactamase.
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“Medical tourism” to India for many surgeries — cosmetic, dental and even organ transplants — is becoming more common as experienced surgeons and first-class hospitals offer care at a fraction of Western prices. Tourists and people visiting family are also sometimes hospitalized. The Lancet researchers found dozens of samples of bacteria with the NDM-1 resistance gene in two Indian cities they surveyed, which they said “suggests a serious problem.”
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Also worrying was that the gene was found on plasmids — bits of mobile DNA that can jump easily from one bacteria strain to another. And it is found in gram-negative bacteria, for which not many new antibiotics are being developed. (MRSA, by contrast, is a gram-positive bacteria, and there are more drug candidates in the works.)
r€nato
In related news, Arizona Gov. Jan Brewer held a press conference today to propose a new law enacting harsh prison terms on illegal alien bacteria which enter the state.
Maricopa County Sheriff Joe Arpaio deployed deputies to Phoenix area hospitals to examine patients for signs of ‘foreign’ bacteria and jail those who have them for, ‘harboring illegal alien bacteria’.
OK, I’ll stick with my day job.
Sheila
I agree this is worrying, but the fact that Western medicine might have a financial stake in denigrating medicotourism in Southeast Asia does make me a little skeptical.
Scott
Hey, don’t go hatin’ on the invisible hand of the free market.
D. Mason
Oh no! It’s the new bird aids? Everyone get your vaccines now! Only $39.95..
El Cid
@Scott: Exactly. The protectionist Luddites in the US have no faith in the comparative advantage of our microbes in the long run.
Booger
I don’t care about the invisible hand of the free market as long as it washes itself thoroughly and regularly. To stop the spread of them germs, you know?
Randy P
My recent reading has included some Greg Bear sci-fi novels lately, a lot of which have a heavy biological/genetic/virus theme. Some of them are kind of disturbing and depressing.
In one of them, a biologist gives bacteria the capability to remember and learn and (collectively) think. Not pretty what happens when they discover the existence of people.
The one I’m reading now, “Darwin’s Children” is depressing because the political situation (a rabid right-wing who is in the majority in Congress) is only a minor extrapolation from today. The rhetoric that leads to concentration camps for mutated children is completely inline with people like Rush or Michelle Bachman. Actually, Rush and Fox are still very much active in this book. The acceptance in the general public for the complete abandonment of civil liberties and any semblance of due process is depressingly familiar. Which is probably Bear’s point.
MattF
The linked NYT article is pretty interesting, and includes various caveats about how scary this may or may not be.
As noted, this is a victory for the free market– you may get a cheaper nosejob in New Delhi, but the market-clearing price includes the possibility of an incurable infection.
mclaren
Notice that this is happening precisely at the moment America’s medical-industrial complex is entering its final stage of breakdown, courtesy of out-of-control costs.
Experts says it’s not a matter of when an antibiotic-resistant pandemic hits Europe and North America, it’s a matter of when.
Combine the collapse of America’s medical system with something like this, and you’ve got the harsh but definitive solution to reforming our broken health care system. When Americans get turned away from hospitals because they can’t afford the ever-increasing insurance premiums and then infect others to produce a pandemic, you’ll see burning cities, mountains of corpses, hospitals demolished by rioting mobs and whole counties turned into morgues. National guardsmen enforcing quarantine while wearing hazmat suits. Bonfires burning dead bodies. It’ll be medieval.
That’ll spur some changes. You won’t hear a lot about how it’s too expensive to fix our broken medical system after that kind of hecatomb. Plagues have a way of clarifying the mind.
twiffer
latest issue of “discover” has an article about research into distrupting bacterial communication. basically, they mess with the chemical signals that bacteria send out to annouce their presence. seems that many dangerous bacteria do not pose a problem until they have a quorom. then they rampage. by fuzzing their communication, they never realize when they have reached that critical mass. the (assumed) benefit is that no resistence would develop, since the bacteria are not being killed; just fucked with (basically).
it’s an interesting take, and in conjunction with reports like this, timely research as well.
mbarnato
For some reason, I pulled out “The Coming Plague” by Laurie Garrett (1994) to leaf through earlier this week. There are so many possibilities for viruses & microbes to cause a worldwide pandemic beyond anything we’ve experienced. It’s pretty clear we’ve dodged a bullet so far. I hope we do keep dodging it, but I think it’s a matter of when, not if, we get hit…
Brachiator
@r€nato:
We obviously need a border fence to keep undocumented bacteria out of the country.
Meanwhile, good old Real American(tm) bacteria have been renamed to be called Freedom Germs.
Sarah Palin can see pandemics from her house, also too.
Mike in NC
Who’ll be the first member of Congress to call for a Global War on Muslim Bacteria?
Linda Featheringill
There is a vaccination against bacterial pneumonia but according to MedicineNet it covers only a large portion of the Pneumococcus family and will not protect you against Klebsiella.
And of course E. coli, like savoir faire, is everywhere.
ruemara
ugh. I can see my job as info officer may get a touch harder in the next few years.
Tax Analyst
@Booger:
Don’t you know where that hand has been?
Joel
1) most antibiotic resistance genes are carried on plasmids.
2) proper hygiene is the best defence.
PeakVT
NPR had a decent segment on MSRA yesterday.
Tax Analyst
@twiffer:
Yeah, but what does the Bible have to say about it? Because if the Bible doesn’t recognize this research it’s probably just another one of Obama-Hussein-Hitler’s soshulistic tricks.
These pointy-headed Science-types could be messin’ with God’s plan to send all his good children to Hebbin’. Mark my words, there could be Hell to pay.
Face
Read an article aways back that basically poo-poo’d the idea that humans could grow into a population size too large for the Earth (although some think we’re already there). The check was that Mom Nature’s vast arsenal of bacteria and viruses would eventually put the kibosh on a significant number of people first. HIV and Ebola may have been the first salvo, and this could be the next round.
Anoniminous
Bacteria, the sluts, go around sharing DNA sequences. Anti-biotic resistance via e-v-o-l-u-t-i-o-n within species has been studied and confirmed through countless studies since the mid-70s. Only a matter of time before it started spreading across species.
Basic hygiene protocols will protect you 90% of the time. The other 10% is direct physical contact with mucus membrane and there’s not much you can do about that without masking, gloving, and carrying around a re-breather with bacteria filters on the input side.
Alwhite
And yet another example of “we are so fucked” sigh
Somebody please convince me there is some way out of the multiple deathtraps we have set for our species.
I want a bumper sticker for the new economy “I was fisted by the invisible hand”
chopper
@Randy P:
that sounds like the sort of book where ‘suspension of disbelief’ means letting half your brain leak out of your head before turning the first page.
mnpundit
@Sheila: If you catch that bacteria I’ll remind you of this post.
Bah, pay no attention to me (not that you would anyway) disease is my personal fear that would make me countenance abrogation of civil rights. It’s my own personal terrorism because once you are infected you are powerless to do anything except agonizingly expire.
Ella in New Mexico
@Joel:
And if I remember my medical microbiology, isn’t plasmid transfer related to water, as in dirty water? Wasn’t the Ecoli 0157 gene a Shigella plasmid transfer gene from water supplies that allowed harmless bac’s to mingle with deadly ones?
Demand scrupulous hand hygiene from your healthcare providers, everyone. It’s really the best way to prevent infections in the first place.
Ken Pidcock
(1) Enterobacteriaceae as systemic infectious agents are almost exclusively associated with immunocompromised patients in hospital settings. As worrisome as it is, this is not something that’s going to spread in the community. (2) We already have carbapenem-resistant enteric bacteria, the KPC carbapenemase strains, for which we have traditionally blamed the goddamned New Yorkers.
Joel
@Ella in New Mexico: Well, sortof.
Plasmid (conjugative) transfer is the prokaryotic form of sexual reproduction, to use a tortured analogy. It’s the most common means of genetic transfer (the other common ones being transformation – the ability to take up and express free genetic material from solution – and transformation – genetic transfer by virus).
All plasmid-containing (F+) bacteria need to pass on those plasmid genes is proximity to a non-plasmid (F-) containing bacteria of the same species. Contaminated water helps a lot, because there’s a lot of bacteria and viruses and other stuff floating around in there.
Interestingly, old fashioned anti-osteoporosis drugs known as bisphosphonates might be useful for preventing plasmid transfer and the spread of antibiotic resistance. Worth watching, to say the least.
John Ferguson
The reason there are few new antibiotics is that the FDA has raised the bar so high for new drugs that pursuing relatively low-value drugs–like a 3rd- or 4th-line antibiotic–is rarely cost effective.
If we want new drugs, particularly those for rare diseases or for later-line treatment of infections, the FDA needs to return to a less stringent approach to approving new drugs.
Yes, there will be rare instances where drugs are marketed that have unforeseen adverse effects. Nobody wants this to happen, but the fact is, everything in life is dangerous. Even peanuts.
Joel
Erm, rereading.
The virus-mediated transfer of genes should read “transduction”.