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Will Global Travel and Microbial Mutation Bring Us a World Without Antibiotics?

Posted By Prucia Buscell, Thursday, August 19, 2010
Updated: Thursday, February 17, 2011
Will disease-causing pathogens eventually outsmart all the drugs designed to kill them?

The emergence of a dangerous mutation that can make some bacteria resistant to almost all known antibiotics has infectious disease experts worried. The rise of antibiotic resistance has concerned scientists for years, but the new mutation poses some new threats. The mutation, called MDN-l, jumps easily from one strain of bacteria to another, and it has been found in gram negative bacteria such as Klebsiella pneumoniae, which has already caused outbreaks in hospitals in the US and abroad.

The British medical journal Lancet Infectious Diseases has reported that bacteria with the MDN-l gene has become increasingly common in India and Pakistan and has been found in patients in the United Kingdom and the US who received medical care in those countries. The Lancet story "Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study," says isolates from India were from community acquired infections, indicating MDN-1 is widespread in the environment. The authors say the problem is serious, and that possibilities for international spread are "clear and frightening." The mutation makes e. coli and Klebsiella pneumoniae bacteria resistant to nearly all powerful carbapenem antibiotics, often the last resort when other drugs have failed.

A New York Times story by Donald McNeil says the CDC noted the first three cases of NDM-l in US patients in June and advised doctors to be alert for MDN-l in patients who received medical care in South Asia. (The initials, the Times story says, stand for New Delhi metallo-beta-lactamase.) Experienced surgeons and sophisticated hospitals in India provide less expensive care than is available in Europe and the US, increasing the number of medical tourists seeking organ transplants, cosmetic surgery and other complex treatments.

One of the Lancet authors, Tim Walsh, is quoted in a Guardian story by Sarah Boseley as saying the emerging mutant may herald the end of antibiotics. "This is potentially the end," he said. "There are no antibiotics in the pipeline that have activity against MDN-l producing enterobacteriaceae. We have a bleak window of maybe 10 years where we are going to have to use the antibiotics we have very wisely, but also grapple with the reality that we have nothing to treat these infections with."

MRSA and Clostridium difficile, two other common health care-associated infections, are gram positive. Gram positive and gram negative bacteria differ in the structure of their cell walls. The Lancet article says gram negative bacteria pose the greater threat to public health because increase of resistance is faster in gram negative bacteria, and because few new antibiotics are being developed to treat gram negative bacterial infections and none fight MDN-l.

Henry Blumberg, a professor of medicine and epidemiology at Emory University School of Medicine, was not involved in the study, but he is alarmed about the emergence of multi-drug resistant organisms. "We are getting close to the post-antibiotic era," he is quoted as saying in a PBS news blog by Talea Miller. "We are going to have organisms that are resistant to all the antibiotics we have" and that are essentially untreatable. The end of antibiotics could plunge medicine nearly a century backwards.

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