Maryn McKenna

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NDM: "A Great Challenge for the Future of Healthcare"

April 29, 2014 By Maryn Leave a Comment

Jason Scragz (CC), Flickr

Jason Scragz (CC), Flickr

A paper published this week reminded me to take a fresh look at NDM, the “Indian superbug” — actually a gene and enzyme — that got so much attention, including from me, in 2011. (Most of the posts are here.) Quick reminder: NDM surfaced in 2008 in Sweden, then was found in the United Kingdom, then in the United States and then elsewhere in the world. It had several distinctive qualities. It appeared in gut bacteria such as Klebsiella and E. coli, and caused infections when those bacteria escaped the gut and got elsewhere in the body. It rendered those bacteria not-vulnerable to almost all antibiotics, leaving so few drugs to use against it that medical personnel found it truly alarming. And it had strong links to South Asia: The first known patient was an Indian man living in Sweden who had gone home for a visit and been hospitalized; victims found later either had family links to India and Pakistan or had gotten medical care there, as medical tourists or because they were injured while traveling.

NDM (which stands for New Delhi metallo-beta-lactamase; it was originally NDM-1, but there are now at least seven variants) generated a lot of alarm at the time, with good reason. Its unusual resistance pattern made useless the last category of broad-spectrum, last-resort antibiotics, called carbapenems, that were still working reliably. Physicians treating patients who had infections involving NDM had to hunt among just a few remaining drugs that were still on the shelf because they were toxic or did not work reliably. Plus, because bacteria carrying the NDM resistance factor colonize the gut, the infection could be transported across borders and into hospitals without anyone noticing. With no symptoms showing, few hospitals would bother to check a patient (or a family member), especially since testing for gut bacteria is more complicated and intimate than, for instance, testing someone’s nostrils for MRSA.

By last year, NDM had mostly dropped out of the headlines, even though it was still moving across the globe (this 2013 paper details countries where it has been identified), and had also begun causing hospital outbreaks (for instance, this one in Denver in 2012). So the new paper I mentioned, written by staff from Public Health England and analyzing the first 250 patients with NDM in the UK, is a useful reminder of how formidable a microbiologic foe this can be.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CRE, NDM, NDM-1, Resistance

'Nightmare Bacteria' Attack an ICU and Close a Burn Unit

August 1, 2013 By Maryn Leave a Comment

Flickr: Denis Bocquet, CC

I thought I was done for the time being with “nightmare bacteria” (the US CDC’s characterization of disease organisms resistant to the last-ditch antibiotics called carbapenems), but there are two stories today that deserve to be called out as examples of how rapidly and dangerously these pathogens are spreading.

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Filed Under: Science, Science Blogs, Superbug Tagged With: Acinetobacter, antibiotics, carbapenems, CRE, CRKP, KPC, NDM-1, Resistance, Science Blogs

More on 'Nightmare Bacteria': Maybe Even Worse Than We Thought?

July 30, 2013 By Maryn Leave a Comment

Flickr: CelesteH, CC

In my last post I talked about the under-appreciated emergence of “nightmare bacteria” (those are the Centers for Disease Control and Prevention’s words, not mine) that are widely distributed in hospitals and nursing homes around the world and do not respond to a last-ditch small family of antibiotics called carbapenems. That seemed dire enough, but new research suggests the problem, bad as it looks, has been understated.

There’s an ahead-of-print article in Antimicrobial Agents and Chemotherapy whose authors include David Shlaes, a physician-researcher and former pharmaceutical executive, now consultant, and Brad Spellberg, an infectious disease physician on the UCLA medical faculty and author among other books of Rising Plague, about antibiotic resistance. In a commentary examining the Food and Drug Administration’s promised “reboot” of antibiotic development rules, they analyze privately gathered data on resistance in the United States and conclude the incidence of highly resistant bacteria is greater than the CDC has estimated.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CDC, CMO, CRE, CRKP, drug development, FDA, KPC, NDM-1, Resistance, Science Blogs

Where 'Nightmare Bacteria' Came From, And How Our Inattention Helped Them Emerge

July 25, 2013 By Maryn Leave a Comment

Zebbie (CC), Flickr

Cast your minds back a few months ago, to when the director of the US Centers for Disease Control and Prevention announced, “We have a very serious problem” with “nightmare bacteria,” and the chief medical officer of the United Kingdom backed him up a few days later, describing a “ticking time bomb” that threatens national security as seriously as terrorism.
[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CDC, CMO, CRE, CRKP, KPC, NDM-1, Resistance, Science Blogs

The 'NIH Superbug': A New Case, And An Overlooked Resource

September 17, 2012 By Maryn Leave a Comment

News, via the Washington Post‘s hard-working health reporter Brian Vastag: After 6 months with no cases, carbapenem-resistant Klebsiella has surfaced again at the Clinical Center of the National Institutes of Health, and has killed a boy from Minnesota who came to the specialty hospital after a bone-marrow transplant meant to address an immune deficiency. This sad event makes the boy the 19th patient to contract the extremely resistant hospital organism, and the 12th to die from it, since the outbreak began.

You can find here my last post analyzing this outbreak (which was originally reported by the Post following a write-up by NIH staff in the journal Science Translational Medicine). I’m looping back to the subject not just because of this new death, but also to add a few new publications to the discussion, one of them mine.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CRKP, Klebsiella, KPC, NIH, Resistance, SciAm, Science Blogs

The 'NIH Superbug': This Is Happening Every Day

August 24, 2012 By Maryn Leave a Comment

I mentioned in my last post that I’ve been away on assignment and have been trying to catch up to an onslaught of news. One of the things that broke while I was gone was a new paper in Science Translational Medicine describing the ferocious impact on a hospital at the National Institutes of Health of the arrival of carbapenem-resistant Klebsiella pneumoniae, known for short as KPC or CRKP.

Even though the news is now several days old — the paper went live at noon Wednesday and has been covered in most major media since — I think it’s worth doubling back to take a closer look. Because, with all respect to my media colleagues, I think some of this week’s stories have omitted the larger context. So, a different kind of post for me — less news, more analysis, based on this book, this magazine story, and these past posts on antibiotic resistance. Here we go:

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Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CDC, CRKP, Klebsiella, KPC, NIH, Resistance, Science Blogs

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