No acute danger to the population from NDM 1

Kiel, 7. September 2010 Ever more frequently in the last weeks, one hears and reads that the bacteria NDM-1 is said to be increasingly found in Europe. What kind of bacteria is it and is there cause for concern among the population? What effect does it have and what distinguishes it from other types of bacteria? Dr. Anette Friedrichs of the Cluster of Excellence in Inflammation Research, specialist in medical microbiology, virology and infectious disease epidemiology and expert on the resistance of bacteria to antibiotics, explains the background and contexts.

What exactly is the NDM-1?

Dr. Anette Friedrichs: „The NDM-1 is not a new bacterium, but the abbreviation for ‘New Delhi metallo-beta-lactamase-1’. It is the name of a resistance gene that can be found in the genome of bacteria. It can provide the bacterium with the ability to be inured, that is, resistant, also to reserve antibiotics, such as the class of carbapenems. These are the preferred antibiotics for use in intensive care in hospitals. The emergence of resistance to this class of antibiotics is in itself not new. What is new with the NDM-1 is that this gene is located on a mobile genetic element and the resistance property can therefore be exchanged between bacteria of different species. So far, NDM-1 has been detected mainly in Klebsiella pneumoniae and other enterobacteria. The group of enterobacteria populates primarily our intestines. They can cause diseases such as urinary tract infections, but also respiratory pneumonia.“

Is there an antidote for NDM-1?

Dr. Anette Friedrichs: „Yes, there are theoretically two classes of antibiotics that NDM-1 is not resistant to – one is a colistin and the other is tigecyclin. The limitation theoretically relates to the effectiveness of both classes of antibiotics. It depends on the location of the infection in the human body and the severity of the disease. Accurate antibiotic susceptibility testing in a microbiology laboratory is essential in every case.“

Are the bacteria with the NDM-1 mutation dangerous to humans?

Dr. Anette Friedrichs: „NDM-1 carrying bacteria are not more dangerous or more virulent than other bacteria of the same species that do not carry the gene. In the case of an infection with NDM-1 carrying bacteria, it may be that the antibiotic therapy is not optimal and sufficiently specific.“

Is there currently an increased risk of infection for Germany’s population?

Dr. Anette Friedrichs: „No, there is no acute risk of the population contracting an infection. There is as yet no evidence of an increased incidence of NDM-1 carrying bacteria in Germany. The Robert Koch Institute, for its part, has in recent years established a system for monitoring antibiotic resistance in Germany in order to identify tendencies in the development of antibiotic resistances as early as possible. Based on the available data, the prevalence of NDM-1 associated resistances is currently estimated to be very rare. The infection is carried by patients who are colonized with NDM-1 carrying bacteria. The bacteria in the context of a contact infection are usually transferred from one patient to another due to insufficient hand hygiene. For prevention it is therefore advisable to always be vigilant about adequate hygiene measures.“

Is it possible to combat the NDM-1 resistance gene separately, and, in the medium to long term, separate it from the bacteria again?

Dr. Anette Friedrichs: „Unfortunately, the opposite is true: bacteria have a formidable survival interest and are highly flexible. Once a resistance gene has entered the world, it cannot be eliminated. Moreover, because the bacteria are exposed to the increased use of broad spectrum antibiotics, it causes enormous selection pressure for them to develop further new and permanent means of resistance in order to ensure their survival. The undirected use of broad spectrum antibiotics promotes this build-up of resistance of bacteria against a number of antibiotic classes and thus accelerates the emergence of resistance genes such as NDM-1. The consequences for the health care system are ultimately a huge increase in costs due to longer treatments with expensive pharmaceuticals. In Germany, the spread of resistance against reserve antibiotics such as the class of carbapenems has been contained due to good control. Studies from other European countries such as Italy or Greece reveal a not to be underestimated threat for both the patients as well as the health care system, when not enough importance is attributed to the problem of the increasing spread of antibiotic resistance. New antibiotics for the treatment of infections through multiresistant bacteria, such as NDM-1 carrying bacteria, are not in sight for the coming years.“

Please refer to the following source for citations of Dr. Anette Friedrichs:

Dr. (Anette) Friedrichs, Cluster of Excellence in Inflammation Research.

A picture of Dr. Friedrichs is available on request.

About Dr. Anette Friedrichs:

Dr. Anette Friedrichs is a specialist in medical microbiology, virology and infectious disease epidemiology as well as an expert on the resistance of bacteria to antibiotics at the Medical Clinic 1, University Medical Center Schleswig-Holstein, Kiel Campus, which is affiliated with the Schleswig-Holstein Cluster of Excellence in Inflammation Research. Her scientific priorities are: the surveillance of antibiotic resistance, molecular epidemiology, and the development of molecular biological detection methods for diagnostic investigation and for monitoring pathogens.

The Schleswig-Holstein Cluster of Excellence in Inflammation Research

The Cluster of Excellence in Inflammation Research takes a unique interdisciplinary research approach in order to decode the causes of chronic inflammation and to develop therapies for cures. The research association combines the expertise of some 200 geneticists, biologists, nutritionists and doctors of the universities of Kiel and Lübeck, the Research Center Borstel and the Max-Planck-Institut for evolutionary biology, Plön. Several million people in Germany alone suffer from chronic inflammation of the lungs (asthma), skin (psoriasis), intestines (Crohn’s disease) and brain (Parkinson’s disease). The trigger is a malfunction of the immune system: it incessantly activates inflammatory messengers and defence cells, which thereby destroy healthy tissue. The number of people affected increases daily. This phenomenon of modern civilization has become the challenge for medical science in the 21st Century.

Business office of the Schleswig-Holstein Cluster of Excellence in Inflammation Research:

Dr. Helga Andree, Managing Director, Cluster of Excellence in Inflammation Research, Christian-Albrechts-Platz 4, 24118 Kiel, T: +49.431.880-4850, E: info@inflammation-at-interfaces.de

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