Facts on New Delhi Metalol-Beta-Lactamase (NDM 1)

They learn to mutate, change their structure and become resistant to any antibiotics that come their way. This was first discovered soon after penicillin was first introduced in the 1930’s and with the advent of WW2, there was a significant rise in infections that could not be cleared up with penicillin. This lead to more testing, stronger antibiotics, more use of antibiotics and subsequently, the bacteria became that much smarter, that much stronger and more able to resist the antibiotics.

Humankind has not helped matters either, with poor hand washing techniques, use of not using gloves until the early 1980’s for every procedure, people not taking the full course of antibiotics prescribed or taking them incorrectly, and the use of administering antibiotics for viral infections. The most prevalent resistant infection up to now has been methicillin resistant staphylococcus aureus (MRSA) which has been successfully treated with the intravenous drug Vancomycin. However, even with the use of this antibiotic the bacterial infection MRSA itself has been known to become colonized, which in turn can cause re-infection again at a later date. This also makes retreatment that much more difficult and time consuming. MRSA has been found most often in infections of the skin, infected surgical sites and lung infections. Healthcare workers exposed to the infection for several years often test positive to MRSA when cultures are done of nasal, axilla and groin areas although no treatment is given as they are asymptomatic.

The newest resistant infection has come from India, hence the name New Delhi, and has been found in enteric infections or infections of the intestines. Klebsiella pneumonia, Escherichia coli and enterobacter cloacae are bacteria that are found naturally occurring in the intestines and they assist with the digestion and breakdown of food. However, once an infection occurs the bacteria mutate and neutralize any antibiotics. This is accomplished by the use of enzymes of the bacteria itself, the Klebsiella, E.Coli and E.Clocae bacteria changes the enzymes and in effect, renders the antibiotic powerless and makes the bacteria stronger.

Signs and symptoms will depend on which bacteria the infection has attached itself. For instance, if E Coli is the culprit the person may experience diarrhea, if Klebsiella Pneumonia is involved there may be signs of upper respiratory infections, fever, blood in sputum, and if enterobacter is the cause there may be soft tissue as well as abdominal symptoms present such as infection at surgical sites, gastric distress, fever, upper respiratory infections, urinary infections and rapid heartbeat.

Also of note is the fact that people who have undergone cosmetic surgery in India or Pakistan have returned to the United States, The United Kingdom or Europe with signs of this resistant bacterial infection. The Center for Disease Control has asked all practitioners to send cultures of the infection to them so further studies can be done to find the best course of action. In the meantime extremely proper infection control methods must continue to be used. These include:

·         contact isolation for persons infected with NDM 1,

·         good hand washing lasting for 15 to 20 seconds with antibacterial soap,

·         washing of hands to be done before and after touching the patient,

·         administering food or medications,

·         before and after use of the restroom ,

·         whenever changes of dressing are done both before and after and whenever gloves are visibly soiled,

·         use of gloves for all procedures,

·         proper disposal of contaminated dressings

·          instructions to the patient and the family concerning infection control measures.

The medication currently being used to combat NDM1 is aztreonam (a monobactam antimicrobial) and with time and study, the best antibiotic to treat and kill this bacterium will be isolated and put into use. There are many resistant infections in the world today, MRSA is not the only one, there is also VRE (Vancomycin Resistant Enterococcus) as well as a tuberculosis infection resistant to medications.

The CDC and the healthcare community together can work to combat NDM 1 and stop its spread but only with teaching and proper infection control measures will this be facilitated. Hand washing, done properly, and the use of personal protective equipment by healthcare workers are the best way to prevent the spread of any infection.