South African Statement On NDM-1 Cases

 

Inoculated MacConkey agar culture plate cultivated colonial growth of Gram-negative, small rod-shaped and facultatively anaerobic Klebsiella pneumoniae bacteria. – CDC PHIL.

 

# 5915

 

Over the past week a story emerged from South Africa regarding (initially 9, now 10) patients in a private hospital who were diagnosed with an NDM-1 bacterial infection.

Crof, at Crofsblog covered these reports here, here, and here.

 

Three of these patients have reportedly died, but local authorities have pointed out that all three had `co-morbidities’ that probably played a major role in their deaths.

 

NDM-1 gained prominence a little over a year ago with the publication of a Lancet article (see NDM-1: A New Acronym To Memorize) that tied India and Pakistan to the emergence and spread of an enzyme that confers resistance in common gram negative bacteria like E.coli and Klebsiella against most antibiotics.

 

Today the South African Department of Health has posted a statement regarding these recent cases. While calling NDM-1 a `national concern’, it provides little in the way of specifics on this outbreak, and instead seeks to reassure that everything is under control.  

 

 

Emergence of NDM-1 in South Africa a national issue

Joint media statement issued by the National Department of Health and Life Healthcare

20 October 2011

 

The emergence of the Klebsiella pneumoniae producing NDM-1 enzyme in South Africa is a matter of national concern. It should be noted that the institution-based outbreak is contained through the effective measures implemented thus far. The possibility of further spread is limited.

 

NDM-1 was identified at Life The Glynnwood Hospital in Benoni, where 10 patients treated were confirmed to have NDM-1. An outpatient at Charlotte Maxeke Hospital in Johannesburg was earlier also confirmed with this multidrug resistant strain of bacteria. There are presently still three patients in Glynnwood Hospital with the NDM-1 bacterium who are in a stable condition.

 

Representatives of the national, provincial and district departments of health met with Life The Glynnwood management and with representatives of Life Healthcare (of which the hospital forms part) as well as with other key roleplayers on Wednesday (19 October) to assess the situation and determine the way forward.

 

Life The Glynnwood was commended for identifying the NDM-1 strain promptly and implementing effective interventions to respond to the outbreak and prevent its spread. These measures include effective treatment and isolation of affected patients, strengthening infection control measures, screening of around 400 patients and staff as well as commissioning an independent clinical audit.

 

A co-ordinating outbreak response team was formed that will meet regularly to monitoring and redirect response to the outbreak when needed. A monitoring system within public and private sector will also be set up.

 

A formal report is being compiled and will be submitted to the Minister of Health. The parties will furthermore work together in formalising a NDM-1 treatment protocol for clinicians. They will also document lessons learned from the experience at Life The Glynnwood to share with other roleplayers. These actions will be of immense value to other hospitals which may be faced with a similar situation in future.

 

Prof Adriano Duse, an appointee of the Department of Health and the Head of Clinical Microbiology and Infection Control at Wits University as well as the National Health Laboratory Services (NHLS) will continue to be the spokesperson on the NDM-1 outbreak.

NDM-1 Surveillance

 

 

# 4880

 

 

 

Just short of a month ago a new form of antibiotic resistance called New Delhi metallo-ß-lactamase-1, or NDM-1 for short, made headlines in the wake of the release of a Lancet study called:

 

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

 

Like many health bloggers, I wrote several times on this mutated gene that can confer resistance to some types of gram negative bacteria against our most powerful antibiotics.

 

NDM-1: A New Acronym To Memorize

Public Health Agencies On NDM-1

Denialism and NDM-1

 

But arguably the best coverage came from Maryn McKenna on her Superbug Blog  here and here. 

 

Since then, we’ve seen a few scattered media reports of cases of NDM-1 that have been detected in nations around the world, some political outrage and posturing from India regarding the naming of the gene, and little else of note.

 

Unlike a pandemic, which can explode around the world in a matter of weeks or months - this is going to be a slower evolving story.

 

It may take years for NDM-1 to become widespread – so news stories right now are mostly about the potential threat. 

 

Which brings us to a pair of reports today, one out of Japan and the other out of Taiwan, regarding surveillance for this new health threat.

 

 

First, from  Agence France Presse we get a report on Japan’s intention to conduct a nationwide survey on NDM-1, after their Health Ministry confirmed their first case last week.

The Health Minister also announced a tightening of hospital reporting requirements.

 

Japan plans nationwide survey for NDM-1 superbug

(AFP)

 

 

Although Taiwan has yet to identify any residents with NDM-1, their CDC (Center for Disease Control) announced today that they have classified this newly identified form of antibacterial resistance as a reportable communicable disease.

 

Doctors and hospitals are now required to notify the Taiwanese CDC if they encounter any suspected NDM-1 cases, particularly if a patient has returned from Pakistan or India.

 

More details are available from this Focus Taiwan news article.

 

CDC to list new superbug NDM-1 as communicable disease

2010/09/07 15:56:59

 

 

It should be noted that Japan’s only known case of NDM-1 resistance came from a man in his 50’s who was hospitalized in April 2009 after returning from India with a high fever.

 

He remained hospitalized until October of last year, and then was discharged.  

 

After The Lancet article was published last month, staff at the Dokkyo Medical University Hospital went back and examined a preserved sample from the patient, and identified the NDM-1 gene.

 

Media reports indicate the patient has since been tested for the NDM-1 gene, and found clear. The hospital also states that the infection did not spread within their facility.

 

While `breaking news’ stories are few and far between regarding NDM-1, the evidence suggests that the gene is spreading slowly, but insidiously around the world.

 

Over time, a combination of good surveillance and solid scientific analysis should give us a much better idea about the scope of the threat posed by this newly emerging antibiotic resistant gene.

A Couple of Referrals On NDM-1

 

# 4806

 

 

Overnight Crof published his reflections on this past week’s big story about concerns over a growing type of antibiotic resistance known as NDM-1.  

 

As usual, Crof’s comments are insightful and well worth reading, so start your morning with:

 

The week of NDM-1

 

 

Yesterday Maryn McKenna gave a short (7 minute) radio interview on NPR’s morning news show, The Take Away. 

 

As usual, Maryn brings clarity to a confusing story. Listen to her interview at:

 

The 'Superbug': Imagining A World Without Effective Antibiotics

 

 

 

I’m working on a slightly different angle to the NDM-1 story this morning, which I hope to post later today or tomorrow.