From the World Health Organization’s latest bulletin (Volume 88, Number 11, November 2010, 797–876), a Q&A with an infectious disease expert on the growing global concerns over antimicrobial resistance from the NDM-1 gene, and other resistant bacteria.
A brief excerpt below, but follow the link to read it in its entirety.
When the NDM1 enzyme-containing “superbugs” struck in India, Pakistan and the United Kingdom earlier this year, media reports blamed medical tourism for its spread. But in this interview, Professor John Conly argues that the overuse and misuse of antibiotics leading to antimicrobial resistance – the theme of World Health Day 2011 – is the more important topic.
John Conly is a Professor of Medicine, Microbiology and Infectious Diseases and Pathology and Laboratory Medicine at the Centre for Antimicrobial Resistance at the University of Calgary, Canada. He is also the co-director for the Snyder Institute of Infection, Immunity and Inflammation at the University of Calgary, and the former Chairman of the Board for the Canadian Committee on Antibiotic Resistance.
Q: What’s special about this new type of resistance labelled as NDM1?
A: NDM1 is an enzyme that confers resistance to one of the most potent classes of antibiotics, known as carbapenems, but what has been observed is different in many ways to what we have seen to date. This new resistance pattern has been reported in many different types of bacteria compared to previously and at least one in 10 of these NDM1-containing strains appears to be pan-resistant, which means that there is no known antibiotic that can treat it. A second concern is that there is no significant new drug development for antimicrobials. Third, this particular resistance pattern is governed by a set of genes that can move easily from one bacterium to another. Fourth, NDM1 has been found in the most commonly encountered bacterium in the human population, E. coli, which is the most common cause of bladder and kidney infections. A further concern is that of the two drugs potentially capable of treating an infection due to one of these new multiresistant strains, one of them, colistin, causes toxic effects to the kidney in about a third of people.
Q: Is this the doomsday scenario of a world without antibiotics?
A: Unfortunately yes, with these new multiresistant NDM1-containing strains and their potential for worldwide spread. Doctors will face a terrible dilemma when a pregnant woman develops a kidney infection that spills over into the bloodstream with a pan-resistant strain containing NDM1 and there are no treatment options. We are essentially back to an era with no antibiotics.