Maryn McKenna

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2015 Resolution: Accept that Diseases Hop Borders, Don't Dismiss Them, and Don't Panic

January 3, 2015 By Maryn Leave a Comment

Cogdog (CC), Flickr

Cogdog (CC), Flickr

Happy New Year, constant readers. There’s no question that the big public health story of 2014 was Ebola. The African epidemic has now racked up more than 20,000 cases, according to the World Health Organization, which has put together a useful map and timeline of developments since March. If you’d like to look back on the year, the best sum-up by far is the New York Times’ long and beautifully told “How Ebola Roared Back,” and for a sense of what we learned this year — and what we still don’t know — consider reading Helen Branswell’s account, published at the Winnipeg Free Press.

The international health community still must focus on Ebola; the disease is by no means contained. But my New Year’s wish, for those of us outside that community, is that we begin 2015 by accepting that wherever diseases occur, they are going to travel. We had repeated demonstrations of this with Ebola; and as a global community, we didn’t react well. (If you feel like revisiting the cringe-making details, the Today in Ebolanoia Tumblr is still up.)

The disease that really makes this case, though, is the antibiotic resistance factor NDM. Since its original discovery in one person in Sweden in 2008, this snippet of DNA — which makes common infections essentially untreatable — has been carried by patients to at least 40 countries, and spread within those countries to create local hospital outbreaks.

That’s a lot of border-crossing.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Ebola, NDM, NDM-1

Very Serious Superbugs in Imported Seafood

June 11, 2014 By Maryn Leave a Comment

Image: Matsuyuki, Flickr

Image: Matsuyuki/ Flickr

Breaking news today from the Centers for Disease Control and Prevention, out of its open-access journal Emerging Infectious Diseases: Researchers in Canada have identified a very highly resistant bacterium in squid imported from South Korea and being sold in a Chinese grocery store.

The letter reporting the finding was supposed to go live at noon ET, but hasn’t yet. When it does, it will be linked from this page, under the subheading Letters. It is titled: “Carbapenamase-Producing Organism in Food, 2014.”

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, CDC, food policy, food safety, NDM, NDM-1, Resistance

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.

[Read more…]

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

"Superbug" NDM-1 Found In US Cat (ICAAC 3)

September 12, 2012 By Maryn Leave a Comment

News from the ICAAC meeting: The “Indian superbug” NDM-1 — actually a gene which encodes an enzyme which confers resistance to almost all known antibiotics — has been found for the first time in a pet, somewhere in the United States.

When you consider the close contact we have with our pets — letting them lick us, smooching them on the head, allowing them to sleep on the bed — you’ll understand why this could be such bad news. [Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: E. coli, ICAAC, Klebsiella, NDM-1, pets, Science Blogs

CDC: Superbug NDM-1 Spreads Within a US Hospital

June 21, 2012 By Maryn Leave a Comment

Last night, prompted by Michael Coston’s excellent primer on NDM-1 (one of a set of short courses he publishes periodically), I scrolled through the literature to see what had happened recently with the spread of the “Indian superbug” — actually a gene and enzyme that were first spotted in 2008 and create resistance to almost all antibiotics. (My past posts on NDM-1, going back several years, are here.)

There was a lot to see: Cases in countries as varied as Belgium, Japan, Oman, Singapore and China. Indications that transmission of NDM-1, which at first indicated some travel or family connection to South Asia, has become a pan-European problem with clusters in several countries. Concern that international travelers are transporting bacteria containing the gene without realizing it. And, disappointingly, reassurances from within India, in a new study, that it can “easily combat” NDM-1 — though the fact that a study was conducted, as opposed to the problem just being denied out of existence, must be an encouraging sign.

That tour through the literature made me curious what has been happening in the United States since NDM-1 was first identified in patients here two years ago this week, and I made a note to check when I got back to work today. And then the Centers for Disease Control and Prevention forestalled me, by announcing this morning that there have been 13 cases in the United States so far — including two in which the infection apparently spread within the same hospital.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, CRKP, india, KPC, NDM-1, Science Blogs

TDR-TB: The Indian Government Denies It

January 29, 2012 By Maryn Leave a Comment

An update to the news two weeks ago of totally drug-resistant tuberculosis, TDR-TB, being identified in India (and earlier in Italy and Iran): The Indian government has announced that it doesn’t exist, and is putting pressure on the physicians who identified it to say they made a mistake.

Because, of course, that’s going to keep a disease from spreading.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, india, NDM-1, Resistance, Science Blogs, TB, TDR

NDM-1 in India: Drug Resistance, Political Resistance

October 16, 2011 By Maryn Leave a Comment

It’s been more than a year since the “Indian superbug” NDM-1 — not actually a bacterium, but a gene that directs production of an enzyme — hit the news. The enzyme, whose acronym is short for New Delhi metallo-beta-lactamase-1, disables almost all antibiotics directed against it, leaving the bacteria in which the gene appears vulnerable to only two imperfect and sometimes toxic drugs.

The enzyme and its gene, blaNDM-1, were first identified in 2008 in people who had traveled in India or sought medical care in South Asia. Hence its name: Many beta-lactamases, enzymes that denature the very large class of everyday antibiotics known as beta-lactams, are named for countries and cities where they were first identified. Since its identification, NDM-1 has been discovered in patients in more than a dozen countries and has also been found to be widely harboured outside hospitals in India, and in surface waters and sewage there.

The unveiling of NDM-1 clearly caused embarrassment for India, and media and lawmakers there struck back, throwing around intemperate language and claiming the naming of the enzyme was a plot to derail the subcontinent’s medical-tourism industry — even though the Indian doctors had attempted to raise the alarm earlier and had been ignored.

So it seemed like a promising signal of openness when an international conference on antibiotic resistance opened in New Delhi a week ago. But in its wake, just what is going on in India — and whether its government is willing to face up to what might be an international crisis — is less clear than ever.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, E. coli, india, Klebsiella, NDM-1, Resistance, Science Blogs, Who

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