NDM-1 Bacteria

Views:
 
Category: Education
     
 

Presentation Description

No description available.

Comments

By: sweety32 (128 month(s) ago)

send me this ppt

By: sarita1226rita (128 month(s) ago)

download it...

 

By: monabansal30 (131 month(s) ago)

Hi...can i have this presentation...plz send me at [email protected]

By: sarita1226rita (131 month(s) ago)

Hi,, you can download it from this page...

 

Presentation Transcript

NDM-1 Bacteria :

NDM-1 Bacteria Done by : SARAH SUHAIL SALEH Supervisor : Dr. Abdelraof Elmanama

Slide 3:

? ? ? ? ? !!!

What is NDM-1 ?:

What is NDM-1 ? New Delhi metallo-beta-lactamase ( NDM-1 ) is an enzyme that makes bacteria resistant to a broad range of beta- lactam antibiotics. News of this new resistance factor has been percolating in smaller medical reports since June 2010. NDM-1 is the designation for carbapenemases found in enterobacteriaceae.

Enterobacteriaceae with NDM-1 carbapenemases are highly resistant to many antibiotic classes and potentially herald the end of treatment with β-lactams, fluoroquinolones, and aminoglycosides—the main antibiotic classes for the treatment of Gram-negative infections. Bacteria that produce NDM-1 are often referred to as “superbugs” because infections caused by them are difficult to treat. :

Enterobacteriaceae with NDM-1 carbapenemases are highly resistant to many antibiotic classes and potentially herald the end of treatment with β- lactams , fluoroquinolones , and aminoglycosides —the main antibiotic classes for the treatment of Gram-negative infections. Bacteria that produce NDM-1 are often referred to as “ superbugs ” because infections caused by them are difficult to treat.

Slide 6:

This enzyme belongs to plasmids- a snippet of DNA , not on a chromosome , that reproduces on its own and can be transferred freely between different bacteria.

History:

History In 1996, the first carbapenemase (KPC) was isolated from Klebsiella pneumoniae in North Carolina. Since then, it has spread throughout the world, including to Europe, and is a common cause of multidrug-resistant and pandrug resistance among. Developed countries like the USA, Israel, and Greece reported the spread of various carbapenemases well before the emergence of NDM-1.

The Misuse of Antibiotics :

The Misuse of Antibiotics The first clue to the presence of a carbapenemases like NDM-1 comes from the increased minimum inhibitory concentration ( MIC ) values of these bacteria. Doctors in subcontinent have always used high profile antibiotics and high doses for even the most minor diseases. This gives the bacteria an opportunity to be more and more exposed to these antibiotics and compelling them to make new resistance factors.

Slide 10:

The virtual nonexistence of antibiotic policies and guidelines in India & Pakistan is a major driver of the emergence and spread of multidrug resistance in subcontinent. This is augmented by the unethical and irresponsible marketing practices of the pharmaceutical industry, and encouraged by the silence and apathy of the regulating authorities and government .

NDM-1 have been isolated till now in:

NDM-1 have been isolated till now in K. pneumoniae Escherichia coli Citrobacter freundii Enterobacter cloacae Morganella morganii.

First Death:

First Death The first death directly attributed to NDM-1 was in Brussels, Belgium in June 2010. The victim had been in a traffic accident while visiting Pakistan, and contracted NDM-1 in hospital there, while undergoing treatment for his injuries. He died despite being administered colistin , a powerful antibiotic .

NDM-1 Gene: Bacteria says humans; “It’s a WAR!” :

NDM-1 Gene: Bacteria says humans; “It’s a WAR!”

+ve OR –ve ?:

+ve OR –ve ? Bacteria from clinical and non-clinical settings are becoming increasingly resistant to conventional antibiotics. 10 years ago, concern centered on Gram-positive bacteria, particularly methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus spp . Now, however, clinical microbiologists increasingly agree that multidrug-resistant Gram-negative bacteria pose the greatest risk to public health.

Not only …!:

Not only …! Not only is the increase in resistance of Gram-negative bacteria faster than in Gram-positive bacteria, but also there are fewer new and developmental antibiotics active against Gram-negative bacteria in the pharmaceutical pipeline and drug development programs seem insufficient to provide therapeutic cover in 10–20 years.

WHY?? :

WHY?? The increase in resistance of Gram-negative bacteria is mainly due to mobile genes on plasmids that can readily spread through bacterial populations. Moreover, unprecedented human air travel and migration allow bacterial plasmids and clones to be transported rapidly between countries and continents. Much of this dissemination is undetected, with resistant clones carried in the normal human flora and only becoming evident when they are the source of endogenous infections.

Slide 17:

The potential for wider international spread of producers and for NDM-1-encoding plasmids to become endemic worldwide, are clear and frightening.

Carbapenemases :

Carbapenemases Carbapenems are among the few useful antibiotics against multidrug resistant gram negative bacteria particularly those with extended spectrum beta lactamase. However resistance to carbapenems occurs and is mediated by mechanisms like loss of outer membrane proteins and production of beta lactamase that is capable of hydrolyzing carbapenems. Modified Hodge test was positive for all carbapenem resistant isolates.

the carbapenem resistance gene :

the carbapenem resistance gene bla NDM-1 ( bla CMY-4 and bla CTX-M-15 )

Most blaNDM-1 positive plasmids were readily transferable and prone to rearrangement, losing or (more rarely) gaining DNA on transfer. - This transmissibility and plasticity implies an alarming potential to spread and diversify among bacterial populations. - Curiously, many of the plasmids were incompatibility A/C types—a group not commonly associated with multidrug-resistant phenotypes. :

Most bla NDM-1 positive plasmids were readily transferable and prone to rearrangement, losing or (more rarely) gaining DNA on transfer. - This transmissibility and plasticity implies an alarming potential to spread and diversify among bacterial populations. - Curiously, many of the plasmids were incompatibility A/C types—a group not commonly associated with multidrug-resistant phenotypes.

Even more disturbing is that most of the Indian isolates were from community-acquired infections, suggesting that blaNDM-1 is widespread in the environment. :

Even more disturbing is that most of the Indian isolates were from community-acquired infections, suggesting that bla NDM-1 is widespread in the environment.

NDM-1-carrying plasmids in the UK are more diverse and bigger in size (>500 kb) than in India, which suggests greater evolution in UK strains. ** About 41% of patients who were positive for NDM-1 had NO travel or any other links to the Indian subcontinent. ?!! :

NDM-1-carrying plasmids in the UK are more diverse and bigger in size (>500 kb) than in India, which suggests greater evolution in UK strains. ** About 41% of patients who were positive for NDM-1 had NO travel or any other links to the Indian subcontinent. ?!!

First paper on NDM-1:

First paper on NDM-1 “We recently reported a new type of carbapenem resistance gene, designated bla NDM-1 . A patient, repatriated to Sweden after admission to hospital in New Delhi, India, was colonized by K.pneumoniae and Escherichia coli with bla NDM-1 on plasmids of varying size, which readily transferred between bacterial strains in vitro. “

UK:

UK In the UK resistant isolates increased in both 2008 and 2009. Isolates with the NDM-1 enzyme, which was first detected in the UK in 2008, became the predominant carbapenemase-producing Enterobacteriaceae in 2009, accounting for 44% of carbapenemase producers.

Slide 25:

The mean age of the patients was 60 years, many had history of travelling to India or Pakistan within 1 year . They were admitted to hospitals for reasons of renal or bone marrow transplantation, dialysis, cerebral infarction, chronic obstructive pulmonary disease, pregnancy, burns, road traffic accidents, and cosmetic surgery.

Slide 27:

The introduction of NDM-1 into the UK is very worrying and has prompted the release of a National Resistance Alert 3 notice by the Department of Health on the advice of the Health Protection Agency. Several of the UK source patients had undergone elective, including cosmetic surgeries while visiting India or Pakistan. India also provides cosmetic surgery for other Europeans and Americans, and bla NDM-1 will likely spread worldwide.

Slide 28:

Given the historical links between India and the UK, that the UK is the first western country to register the widespread presence of NDM-1-positive bacteria is unsurprising. However, it is not the only country affected. Researchers have already identified bacteria susceptible to the NDM-1 superbug gene in people living in the U.S., Netherlands, Australia, and Canada who have traveled to India for medical care

Tests? :

Tests? Modified Hodge test was positive for all carbapenem resistant isolates. Bacteria were identified via API 20E strips . Minimum inhibitory concentrations (MICs) and carbapenem resistance were established by microbroth dilution or disc diffusion. Modified Hodge test involving distorted carbapenem inhibition zones and imipenem-EDTA synergy tests by disc, or the MBLE test were used to screen for metallo-β-lactamase production. The presence of bla NDM-1 was established by PCR with specific primers targeting the gene.

Slide 31:

A study was released showed a rise in NDM-1 superbug infections in UK hospitals.

Cost to Human Race:

Cost to Human Race Imagine that it will take about 10 years, and about $1 billion dollars, to get a new antibiotic through the development pipeline and into the market. And then imagine that — as has been shown for a number of drugs, most recently the new antibiotic daptomycin — bacteria begin developing resistance to your drug within a year of its deployment in patients. And after that, imagine — as has been cited in a number of papers — that once local resistance to your antibiotic appears in approximately 20% of isolates, physicians will cease prescribing your antibiotic, for fear their patient will be one of that 20%.

So, to recap: 10 years, $1 billion; short course; short market life; rapid obsolescence. :

So, to recap: 10 years, $1 billion; short course; short market life; rapid obsolescence. Who will take the responsibility to stop bacteria from developing resistance ??? Conclusion and How to Prevent it !!!. A uniform antibiotic policy is the need of the hour. Even if we start working on a new class of antibiotics now, it may take several years to deliver, but we can’t shy away from the need for judicious use of drugs. Please compel at least yourself and your surrounding friends not to use so much high profile antibiotics!

Hope?!:

Hope?! Most isolates remained susceptible to colistin and tigecycline. Such bacteria are usually only susceptible to polymyxins and tigecycline.

"For our common bugs to lose the miracle drugs, it is a problem." :

"For our common bugs to lose the miracle drugs, it is a problem."

و إذا كانت الشعوب عظاما *** عجزت في مرادها الحكام اغضبي يا دنيا:

و إذا كانت الشعوب عظاما *** عجزت في مرادها الحكام اغضبي يا دنيا

Slide 37:

THANK Y O U