A New Delhi superbug has made its way into wards and minds of the United States.
A strain of the highly drug resistant common bacterium Carbapenem-resistant Enterobacteriaceae, or CRE, has been found in the Rhode Island Hospital. This particular strain is called Klebisella, and can cause pneumonia and other infections. Two Rhode Island patients have contracted the superbug (super in that it’s super hard to kill) and in doing so have clocked in as the 12th and 13th cases ever recorded in the United States.
I’ve only ever thought of travel as enriching our lives, but now it is being revealed as having jeopardized one. The story goes: a Cambodian woman who lives in Rhode Island became sick with lymphoma in May of 2011 while visiting her homeland. That December, she was hospitalized in Ho Chi Minh City before flying home and being admitted to Rhode Island Hospital for three months, receiving chemotherapy. This February, the woman suffered a bladder infection caused by a different bacterium.This turn of events, however unfortunate for the woman, was in fact a very lucky one for the hospital; she was placed on special infection control precautions, and it is only under this targeted watch that in March, the infectious disease doctor noticed that her urine was cloudy. Samples were sent to the Centre for Disease Control, and came back with a confirmation of NDM-1, the enzyme that enables drug resistance. Fortunately, her immune system cleared the infection.
Stricken with fear, the hospital did bacterial cultures on all other patients in the cancer ward and found only one who had picked it up, but didn’t show any symptoms. The hospital stamped it out fast, but worry spread faster.
There is cause for concern in that the superbug is originally from India – meaning that it is now a transatlantic fear – but more so in that it produces an enzyme, NDM-1, that holds resistance to practically all antibiotics (the one exception being an oldie-but-goodie, colistin). The resistant genes in question are especially a danger because they reside on a plasmid: a circular piece of DNA separate from the bacterium’s essential genome, or “genes for a rainy day” as my biology teacher puts it. These plasmids are easily transferred to other bacteria using the bacterial method of gene exchange called recombination, and all affected bacteria resurface as “extensively drug resistant,” or XDR.
Now that these bacteria have crossed the Rubicon past the heavily armed US border, precautions are being discussed and protocols are being implemented. But, there are some that say we are already beyond precautions and protocols. Mitchell Schwaber and Yehuda Carmeli, two Israeli physicians, warn in the Journal of the American Medical Association that “As these organisms become increasingly prevalent, treatment of health care-associated infections most likely will become more difficult or even impossible. If they become widespread, these XDR bacteria could make the hospital environment unsafe even to the general population.” There are some that are more optimistic, however; Dr. Leonard Mermel of Brown University Medical School writes that “The cat’s out of the bag. It’s spreading. But we need to do what we can – nationally, globally, and locally – to curtail its spread.” Rhode Island hospital decontaminated the entire ward – the bacteria can live on surfaces and medical equipment just as easily as within a host – and managed to cut the XDR’s American joyride short.
This week, the Centre for Disease Control updated hospitals and nursing homes on how to deal with the bacteria. They warn us of their “potential to spread quickly” but advise that with precaution and tact, the bug can be squashed.
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