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The Boston Globe
‘Superbug’ patient treated at MGH
Arrival of the germ in US casts a spotlight on global spread of drug-resistant bacteria
By Stephen Smith, Globe Staff | September 14, 2010
A person infected with a “superbug’’ that is sparking fears around the world was treated earlier this year in a Massachusetts hospital, disease trackers said yesterday. The patient had recently traveled from India, a hot spot for the germ, which is immune to many common antibiotics.
The patient was treated at Massachusetts General Hospital and isolated, a measure that prevented the germ from spreading, said Dr. David Hooper, chief of the hospital’s infection control unit.
“You’ve got to always be vigilant,’’ Hooper said. “We are concerned, not alarmed. With good infection control and following guidelines, they can be held at bay.’’
A medical officer at the US Centers for Disease Control and Prevention said the Massachusetts patient survived, as did the only other two US patients with infections blamed on the superbug, which appears to have been contained.
All three patients developed urinary tract infections that carried a genetic feature that made their cases harder to treat.
Known by the medical shorthand NDM-1 — it stands for New Delhi metallo-beta-lactamase — the gene allows bacteria to escape some of the strongest antibiotics available, a process known as drug resistance.
“It leaves treating physicians with few treatment options,’’ said Dr. Alex Kallen, a CDC officer.
The arrival of NDM-1 in the United States casts a spotlight more widely on the problem of drug-resistant bacteria, which have caused outbreaks in hospitals, gyms, and schools. A germ called MRSA has received the most attention, but it has plenty of company.
“This is just another example of these multidrug-resistant [germs] that we are going to have to come to grips with,’’ said Dr. Alfred DeMaria, top disease tracker for the Massachusetts Department of Public Health.
Global health specialists attending a major meeting of microbiologists and infectious disease doctors in Boston this week said they are particularly concerned about NDM-1 because of its emergence in India.
Antibiotics are cheap and available over the counter in South Asia, specialists said, fueling inappropriate use and, consequently, the development of drug resistance. Poor sanitation can further spread NDM-1, which thrives in germs that proliferate in the gut.
“There are certain factors in the Indian subcontinent that are going to make this spread quite widely,’’ said Timothy Walsh, the Cardiff University scientist who helped discover the germ. “It’s very easy for us to forget in the Western world how desperate the conditions are in some of these countries.’’
The US cases — the other patients were treated in California and Illinois — also illustrate how swiftly germs can spread in an era of jet travel. Scattered cases of NDM-1 infections have been reported elsewhere in Asia, as well as in Europe and Canada.
All three of the US patients had been in India, and two — including the person treated at Mass. General — underwent medical procedures in hospitals while they were there, Kallen said. The patient treated in Boston was an Indian citizen with cancer who had undergone surgery and chemotherapy in that country before coming to Massachusetts, the CDC physician said.
Neither of the patients who spent time in Indian hospitals is believed to have traveled to that country as part of medical tourism — the practice of US and European patients going abroad for surgeries that can cost less
Germs with NDM-1 are typically spread through poor hygiene and not by coughing or sneezing, Walsh said. In India, children playing in sewage could be exposed to the superbug.
In the United States, DeMaria said, the threat posed by the germs is most acute in hospitals. “They don’t cause infection in people walking down the street,’’ he said. “If somebody’s in an intensive care unit on a ventilator with a tube in their trachea, they’re at risk for these organisms. If someone has had extensive abdominal surgery with lots of open wounds, they’re at risk.’’
Only two antibiotics possess a measure of effectiveness against bacteria riddled with NDM-1, doctors said: an old drug called colistin and tigecycline.
The paucity of drugs reflects not only the strength of the superbug but also the long-neglected development of new antibiotics.
While compounds are being studied in labs and some are undergoing human testing, scientists and physicians at the Boston meeting, the Interscience Conference on Antimicrobial Agents and Chemotherapy, expressed little hope that the antibiotic medicine cabinet will expand significantly in coming years.
“There’re some antibiotics that have been talked about at this meeting,’’ Walsh said. “Trouble is we’ve got one or two that look promising, and what we need are six to eight to cover our options.’’
Stephen Smith can be reached at email@example.com.
"...only the shadow knows"