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NDM-1: New Route, Same Destination – Untreatable Infections

Posted on by CDC's Safe Healthcare Blog
Brandi Limbago, PhD
Brandi Limbago, PhD

Author – Brandi Limbago, PhD
CDC’s Division of Healthcare Quality Promotion

You’ve likely seen the news over the last couple of weeks warning people about “The [so-called] New Superbug NDM-1,” a newly discovered gene that makes bacteria resistant to last-resort antibiotics called beta-lactams or carbapenems. NDM stands for New Delhi Metallo-beta-lactamase, and in this case the NDM gene rendered antibiotics useless in three cases of infection with carbapenem-resistant Enterobacteriaceae (CRE). CDC discovered NDM-1 in the United States this year and reported it through the MMWR in June. Is it concerning? Absolutely; and we are working closely with healthcare providers and health departments to stop transmission of these bacteria.

That said, I’d like to point out that the story shouldn’t be solely about these bacteria being new or imported from other countries; the story should be about the whole group of CRE and untreatable infections they cause. In reality, these are not the first CRE cases we’ve seen in the United States. Not even close. NDM-1 is actually just one type of CRE and represents a larger antibiotic resistance issue that we already have, right now, in this country. CDC has been working with partners to prevent a type of CRE known as KPCs (carbapenemase-producing Klebsiella pneumonia). The KPC gene also makes Enterobacteriaceae bacteria resistant to beta-lactam/carbapenem antibiotics, just in a different way than NDM-1. KPCs have been reported in about 35 states and are associated with high mortality – 40 percent in one report. It may be in the other 15 states as well, but has not been reported to CDC. So, let’s not wait for NDM-1 in order to take action.

What exactly is happening with these Enterobacteriaceae? They are Gram-negative bacteria that normally live in our intestines. When not held in check by our body’s normal defenses, these same bacteria can cause serious infections, especially in hospitalized patients with medical devices such as catheters or ventilators. These infections are typically treated with beta-lactams, but when a resistance gene such as NDM-1 or KPC get into the bacteria, the result is a multi-drug resistant organism (MDRO) that can be very difficult to treat.

The good news is that we know strategies to prevent transmission of CRE infections, but more needs to be done. CDC issued guidance in 2009 about CRE transmission prevention, regardless of whether they’re NDM- or KPC-producers. We also have several guidelines on MDRO and other healthcare-associated infection prevention. The challenge now is motivating the healthcare community to take action, including using antibiotics wisely, following transmission prevention guidelines, and implementing overall infection prevention recommendations.

So while I think that all the attention to NDM-1 has raised awareness about the broader CRE problem, which is good, we need providers to take the recommended steps towards prevention. Patients’ lives could depend on it.

What’s your take on this story? How is your organization/unit preventing Gram-negatives?

Read CDC Safe Healthcare Blog posts on Gram negatives. CDC experts are also discussing CRE prevention and NDM-1/KPC on Medscape.

Posted on by CDC's Safe Healthcare Blog

16 comments on “NDM-1: New Route, Same Destination – Untreatable Infections”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    I relished browsing this. I ought to find out alot more about this subject. I’m appreciating hard work you devoted your site, due to the fact it truly is perfect website just where I am able to acquire lots of useful details.

    kindly pls send to me by mail thae last update news about ndm-1 and infection control policy for this subject., and laboratory diagnosis….. thanx

    Daily Magazines
    I am full of admiration and positive feelings. Very nice, clean and pleasant. All the best for the author.

    Would somebody please verify whether it would be safer to test BP over the patient’s sleeve? I assume it might be.

    Eric C
    Surgical.tv

    Emerging new resistant infections is always of concern. Antibiotic overusage is a common problem when facing infections. Prescribe or not is the question. Wise antibiotic usage is key to preventing these mutating infections.

    At our hospital we issue a disposable cuff with each patient. It follows them from floor, to surgery, to PACU, etc.

    What is the best way to screen rectal swabs for NDM-1? Something home-brew, cheap, and efficient (beside PCR of course, more culture-based)

    The above comment about the blood pressure cuffs is a very important one that should have serious attention paid to it. I never thought about it until now. But the cuffs would be another good vehicle to transmit HAIs and I don’t think they get changed between patients. They are probably the, or one of the, most common devises used in medicine by doctors offices, hospitals, urgent-care centers, clinics, ambulance companies, and fire departments among others. I don’t know how hard it would be to develop a replaceable cuff to be changed between patients but it would be a good idea–have disposable cuffs or steralize each cuff between each use to eliminate this possible means of HAI spread.
    The article was teriffic. Basic measures that are not costly and are simple to do can help alot in the control of NDM and KPC as well as other HAIs. Improving communications and getting the word out to the medical community is one of the keys. Then when the medical community gets the information, they need to want to implement it and that will take more incentives, like CMS no longer paying for HAIs and requiring that HAI costs not be passed on to patients. There should also be public reporting of HAI rates in hospitals and nursing homes so that people can use the information to make a more informed choice of which hospital to goto for elective activities and which nursing home to go to. Best wishes, Michael E. Bailey.

    Thanks alot for this valuable informations , but its too difficult to me here in Jordan to impliment asrategy for proper using of antibiotics becuase only the physicins violate the rules always . we dont have obligatory access for these Drs .please know that we are private sector, the Drs is our main stakeholders so we cant manege so please if some one have ideas to stop vague using of antibiotice to help our patients from these weapons to e. mail me thanks

    Thank you for all your hard work at the CDC and writing this insightful article on NDM1. With your valuable help, we will increase our efforts immediately on the issues of antibiotic resistance, and reducing bacteria transmission. Our little group has about 190 medical research scientists from around the world, and we thank you for keeping us informed. The CDC is doing a great job with your interagency task force on Antimicrobial Resistance. Thank you so much.

    Diane Michel
    Global Medical Research.org

    Disease has tobe spread! There is no means of active moving by a disease process. It has to be transmitted by an external force eg: Hands,clothing,medical devices etc.

    Handwashing and contaminated blood pressure cuffs are the same problem. You can wash your hands and reduce the load of disease on your hands yet the most commonly used medical device is the blood pressure cuff and there is total disregard for it being reused from patient to patient. The germ load only increases with every use.

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