The news waves are overflowing with reports that “the new superbug” which originated in India has reached the US shores and is “gaining ground”. Here and here.
I don’t mean to downplay anything but I’m just a tad annoyed. So let me count the reasons why:
First, it was bound to happen. Microbes are smarter than we are and will always be. Using warfare terminology as we are apt to do when discussing microbes when you the patient demand antibiotics from your doctor because you have “an infection” please know that you are providing these microbes opportunities to develop resistance to our limited arsenal of antibiotics. When you the doctor decide that your patient is infected, or may be infected, or perhaps you want to prevent an infection after your sub-optimal procedure and you give that patient broad-spectrum antibiotics “just in case”, again you are giving the enemy (the microbes) classified information that they can turn around and use against us.
Second, there is no new superbug! Hello?! It’s a gene known as New Delhi metallo-beta-lactamase (NDM-1). Metallo-beta-lactamases aren’t exactly new. It’s just that this particular one, with its discovery in New Delhi, India, confers a new mechanism of resistance that allows several different bacteria (ones we already know causes various infections) to become resistant to certain different antibiotics (ie. almost all of them!). The gene resides on a plasmid and the bacteria can share this plasmid and as a result the gene between themselves and even across species. I admit, that is SCARY!
But still, can we please stop calling it a SUPERBUG? Thanks.
Third, the CDC reported this in June. Why are we now going crazy? In that MMWR, 3 patients with three different bacteria (E.coli, K.pneumoniae, E.cloacae) expressing NDM-1 were described. Each had received some kind of medical care in India. Each survived their infection. The three bacteria isolates were resistant to all beta-lactam antibiotics (penicillins, cephalosporins, cabapenems, monobactams)!
Oh by the way, that was a rhetorical question. I’m fully away that ICAAC is underway in Boston, and this is one of the topics being discussed.
Fourth, can the powers that be start funding the search for new antibiotics? I know it’s not as sexy and not as profitable as say Lipitor or Viagra, but please?! Pretty please? With sugar on top? It’s really pathetic to stare at a patient circling the drain and to have to tell the family there’s no other antibiotic to give. A lot of people don’t understand that concept. What do you mean no other antibiotic? An antibiotic is an antibiotic right? WRONG!
It’s daunting to have no option but to try using “detergents” such as colistin to treat a patient’s infection. Colistin fell out of favour decades ago because it was so toxic and harmful to the kidneys, but here we are in 2010 reluctantly pulling it off the shelves for patient use.
I acknowledge that treating infections caused by bacteria which express this NDM-1 gene will be troublesome. I recall the few patients with serious multi-drug resistant Acinetobacter baumanii infections that I have treated in the past with colistin as a last-ditch effort.
We are in uncharted territory. Which old antibiotic should we resurrect next? What dose? What route? How long?Which side effects should we be willing to accept?
One thing is for sure though. MRSA move aside. C.difficile sit down. The multi-drug resistant gram negative posse led by Acinetobacter baumanii has arrived and they aren’t taking NO for answers.
Ha, sadly that is easier said than done.
Limit overuse of antibiotics!
Also, easier said then done.
Leave a Reply