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Keeping Up with the Superbugs

Regular monitoring and molecular testing help prevent dangerous outbreaks of infection.

In the summer of 2010 the influential medical journal The Lancet published an article about the emergence of a new antibiotic-resistant enzyme called New Delhi metallo beta-lactamase, or NDM-1. Produced by certain bacteria, the NDM-1 enzyme makes those bacteria resistant to virtually all antibiotics.

Initial reports of NDM-1 in such countries as Canada, the US and the UK confirmed infections in a small number of patients, virtually all of whom had previously received medical care in India or Pakistan. However, the potential threat of this latest “superbug” – particularly for patients with weakened immune systems in hospitals, where bacteria can easily spread – was enormous.

“None of our regular antibiotics work against NDM, it’s almost untreatable,” says Dr. Miguel Imperial, a specialist in medical microbiology at the BC Centre for Disease Control (BCCDC).

The most effective treatment for NDM-1 is colistin, a toxic older generation antibiotic that must be administered intravenously in hospital.

By October 2010, NDM-1 had been confirmed in four patients in British Columbia.

In the face of this emerging public health threat, the BC Public Health & Microbiology Reference Laboratory – working with the National Microbiology Laboratory in Winnipeg – implemented an improved molecular testing method for NDM-1. The polymerase chain reaction (PCR) assay has been used for many years to identify infectious diseases by revealing their DNA footprint. However, this can be a slow process. With its new fast PCR assay technology, the public health laboratory was able to reduce the turnaround time for NDM-1 test results from up to two weeks to just three days.

Meanwhile, the BCCDC arranged for all microbiology labs in the province to send isolates of any NDM-1-like antibiotic-resistant infections they encountered to its public health lab for PCR testing.

Dr. Judy Isaac-Renton, director of the Public Health Laboratory at the BCCDC Public Health Microbiology & Reference Laboratory says:

We’re staying at the cutting edge of technology by using powerful molecular tools to detect NDM and other organisms like it, and we’re watching for it very closely.

Although speedy identification of NDM-1 is important for improving treatment outcomes for patients, timely confirmation of the superbug is especially important for controlling outbreaks of the infection in hospitals.

“For immunocompromised patients in a hospital ICU, getting NDM could be disastrous,” says Imperial.

As of May 2012, Imperial says NDM has been confirmed in 23 people in BC, second only to Ontario for prevalence of the bacterial infection in Canada.

“There are not a lot of superbugs like NDM in Canada, but we’re staying at the cutting edge of technology by using powerful molecular tools to detect it and other organisms like it, and we’re watching for it very closely,” says public health laboratory director, Dr. Judy Isaac-Renton.

Dr. Miguel Imperial is a physician specialized in medical microbiology and a member of the BCCDC’s Bacteriology & Mycology Program.

Dr. Judy Isaac-Renton is the Public Health Laboratory Director, BCCDC Public Health Microbiology & Reference Laboratory. 

SOURCE: Keeping Up with the Superbugs ( )
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