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Extremely Drug-Resistant Infections Spreading Fast

Common Bacteria Are Picking Up New Antibiotic-Resistant Gene

No New Drugs in Pipeline for NDM Superbugs

Walsh and colleagues isolated NDM-carrying bacteria from a Swedish patient of Indian origin who got a urinary tract infection while visiting New Delhi. They dubbed the new bug NDM-1.

To find out whether it was a freak occurrence, they collected bacteria isolated from sites in India, Bangladesh, Pakistan, and the U.K.

Now they report that from 1% to 4% of Gram-negative bacteria from South Asia carried the NDM gene. In the U.K., the researchers identified 37 NDM isolates from 29 patients, at least 17 of whom recently had traveled to India or Pakistan for medical procedures.

In the U.S., none of the three known NDM-bacteria-infected patients were "medical tourists" -- people who seek less expensive or more readily available medical procedures abroad. But the practice is becoming common. And Walsh, Pitout, and Limbago question the wisdom of the practice.

"This is a risk associated with medical tourism not appreciated before," Limbago says.

Pitout agrees.

"This medical tourism is a major issue. People picking up a drug-resistant bug and bringing it back is a worrying issue for me," he says. "These bugs can spread easily, especially E. coli. We are worrying that they might be spreading in the community."

Why are these experts so worried? It's because when Gram-negative bacteria become resistant to older drugs, there are no new drugs in the pipeline. And that leaves doctors with almost nothing to do for patients with serious infections.

"The only possible thing to do is to treat patients with an antibiotic cocktail and hope it might have an effect. But that is very difficult to do," Walsh says. "You can use high-level dosing, but the danger is you run into toxicity issues."

Is it the end of the antibiotic era? Perhaps not quite yet. Walsh, Pitout, and Limbago say the first thing to do is to get a firm sense of how prevalent NDM resistance really is. Then there must be a major research effort -- perhaps, as Walsh suggests, a global government/industry collaboration -- to find new drugs to kill the bugs.

"We must, must, must consider antibiotic resistance as a global problem," Walsh says. "It is not just in India. This is a prime example how if it starts in one country, it can spread massively throughout the globe."


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