Is the superbug from India or Pakistan

[MarrickG]

Singapore on alert for gene that creates superbugs

THERE is a new gene that could turn any bacteria into a superbug that is resistant to even the most powerful antibiotics.

Fifty Britons have already been infected, many of whom had returned to the UK after undergoing surgery in India or Pakistan.

And earlier this month, a Belgian man became the first known fatality.

The unnamed man had been hospitalised in Pakistan for a leg injury after a car accident, and died after being repatriated to a hospital in Belgium.

The gene, known as the New Delhi metallo-beta-lactamase 1 (NDM-1), is already widespread in India and Pakistan.

So far, there have been no reported cases here, said a Ministry of Health (MOH) spokesman. The Lancet Infectious Diseases journal published on Aug 11 said that NDM-1 bacteria have infected more than 140 people in India and Pakistan.

Superbugs are bacteria that cannot be killed by most antibiotics.

In the case of the NDM-1 gene, it can inhabit bacteria and produce an enzyme that can digest a powerful antibiotic called carbapenem.

Carbapenem is one of the last lines of defence for bacterial infections.

This means that the superbug could potentially spread worldwide without any weapon to stop it. The bug is spread through physical contact with an infected person or any other contaminated surface.

Singapore has to be on the alert as it is an open economy with high tourist numbers.

Said Dr Asok Kurup, an infectious diseases specialist with Mount Elizabeth Hospital: "We are a very global city and vulnerable to these and other kinds of multi-drug resistant bugs carried by travellers and it is important to recognise these superbugs early."

He suggested that screenings be done on selected patients who are at risk.

Superbugs mainly affect people who are in hospital for long periods, have just undergone surgery, are seriously ill or have a weak immune system.

Those in the intensive care unit, on prolonged antibiotic therapy and have other underlying conditions are also susceptible.

But, given time, some of these bacteria can also infect otherwise healthy people, both in the hospital and the community, said Associate Professor Raymond Lin, the head and senior consultant in the Division of Microbiology at the National University Hospital.

Dr Kurup said that in the worst-case scenario, potentially toxic agents with side effects have to be used, either by itself or in combination, to treat a person infected with a superbug carrying the NDM-1 gene.

With the possibility of NDM-1 appearing in Singapore, what can we do to protect ourselves? Prof Lin said: "When you are recovering in the hospital and the doctor is happy to discharge you, don't stay on when there is no need to do so to minimise your risk of infection." v When you fall sick, use antibiotics only when it is prescribed and follow doctor's instructions.

Said Prof Lin: "Do not demand antibiotics for your treatment - let your doctor decide." The MOH spokesman said hospitals here do laboratory testing and monitoring of multi-drug resistant bacteria.

She said: "Hospitals have robust surveillance and infection control measures to tackle the problem of multi-drug resistant bacteria. We will continue to monitor the situation closely." To stop germs from spreading, people are advised to practise good personal hygiene, such as proper and frequent hand-washing, and to observe the strict visitation policy of hospitals to prevent cross infection, she said.

How bacteria can turn into superbugs

The superbug can be spread only through contact with an infected person, surfaces or via an intermediary such as a hospital worker.

1 Multi-drug-resistant bacteria can turn into superbugs with the introduction of the NDM-1.

2 The NDM-1 gene produces an enzyme that can digest a powerful antibiotic called carbapenem.

3 Multi-drug-resistant genes in the bacterium make it resistant to almost all antibiotics