There are fears that without vigilance the enzyme that allows any bacteria to become a superbug could become widespread in NHS hospitals.
It has infected around 50 Britons so far, many of whom returned to the UK after undergoing surgery in India or Pakistan.
The Health Protection Agency (HPA) yesterday stepped up its warnings about the new gene called NDM-1, or New Delhi metallo-beta-lactamose after the place where it was first identified.
Dr David Livermore, director of antibiotic resistance monitoring at HPA, said resistance to one of the major groups of antibiotics, the carbapenems, is found throughout India.
‘This is important because carbapenems were often the last ‘good’ antibiotics active against bacteria that already were more resistant to more standard drugs.’
The first two patients confirmed to have been infected had traveled abroad shortly before they were admitted to hospital in the UK.
One patient carrying the tainted bacteria was transferred to a Nottingham hospital at the end of last year after suffering a trauma injury in Pakistan.
The UK resident was found to have a colony of the enzyme on their skin, which means they have been counted as one of the 50 cases.
However, their infection was not as serious as it could have been. In the worst cases, the enzyme enters the blood stream through an open wound.
The other patient was treated at St Mark’s Hospital in Harrow, London after being diagnosed with Klebsiella, a bacteria in the gut which contains the superbug NDM-1.
Staff isolated the patient and a single staff member per shift was allocated to treating them.
Staff had to wear long sleeve disposable gowns and gloves when in contact with the patient, enhanced cleaning provisions on the ward, and restricted visitors to ensure the bug did not spread to other patients or outside the hospital.
The patient has since been discharged from hospital, and the rooms used for treatment have been fumigated to ensure no trace of the superbug remains in the hospital.
Meanwhile Dr Tim Boswell, a consultant microbiologist at Nottingham University Hospitals Trust, said medics were aiming to keep the spread of the bacteria at bay for as long as possible.
He said: ‘It is obviously very rare but it is definitely a cause for concern that this is a problem for the future.
‘We have got methods of surveillance and picking it up early. That could be a challenge with the high volume of travel in the world.’
Dr Livermore warned: ‘Few antibiotics remain active against these bacteria.
‘Their spread underscores the need for good infection control in hospitals both in the UK and overseas, and the need for new antibiotic development.’
The HPA flagged up enzyme problem last year but renewed its warnings after a study in journal The Lancet Infectious Diseases tracked the emergence of the ‘superbug’ gene in different countries.
The researchers found NDM-1 is becoming more common in Bangladesh, India and Pakistan and is starting to be imported back to Britain in patients returning from these countries.
Several of the British NDM-1 positive patients had recently travelled to the Indian subcontinent for hospital treatment including cosmetic surgery.
Timothy Walsh, professor of medical microbiology and antimicrobial resistance at Cardiff University, who led the study, said it was a ‘real concern’.
‘Because of medical tourism and international travel in general, resistance to these types of bacteria has the potential to tavel around the world very, very quickly.’
He said there are few drugs in development that can potentially combat the threat.
The resistant gene has also been detected in Australia, Canada, the US, the Netherlands and Sweden.
The NDM-1 gene alters bacteria, making them resistant to nearly all known antibiotics.
It has been largely found in E. coli bacteria, the most common cause of urinary tract infections, and on DNA structures that can be easily copied and passed onto other types of bacteria.
The researchers said the superbug gene appeared to be already circulating widely in India, where the health system is much less likely to identify its presence or have adequate antibiotics to treat patients.
Christopher Thomas, professor of molecular genetics at the University of Birmingham who was not linked to the study, said ‘We are potentially at the beginning of another wave of antibiotic resistance, though we still have the power to stop it.’
Prof Thomas said better surveillance and infection control procedures might halt the gene’s spread.
Although patients in British hospitals are unlikely to encounter the superbug gene, they should remain vigilant about standard hygiene measures like properly washing their hands, he added.
‘The spread of these multi-resistant bacteria merits very close monitoring’ wrote Johann Pitout of the division of microbiology at the University of Calgary, Canada, in an accompanying Lancet commentary.
He called for international surveillance of the bacteria, particularly in countries that actively promote medical tourism.
‘The consequences will be serious if family doctors have to treat infections caused by these multi-resistant bacteria on a daily basis’ he added.
The Department of Health spokesman said ‘We are working with the Health Protection Agency. The HPA alerted the NHS in January and July lst year to be vigilant about these bacteria and take appropriate action where necessary.
‘Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to the HPA for testing.’
Source : daily mail uk