First Canadian acquired case of NDM-1 superbug -- in an Ontario hospital

In 2010, a study published in the famous academic journal The Lancet Infectious Diseases flagged the emergence of NDM-1, an enzyme that confers high levels of resistance of gut bacteria to almost all antibiotics, leading to potentially life-threatening pneumonia and urinary tract infections The study concluded, "The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed."

At that time, NDM-1 was widespread in India.

But Canada now has it's first domestically acquired case of NDM-1 -- in an Ontario hospital, according to a new study in the Canadian Medical Association Journal.

A man admitted to a Toronto hospital with a stroke later tested positive for NDM-1. He hadn't travelled outside of southwestern Ontario for the past 10 years; none of his family members or friends had travelled to India. Fortunately, the man remained asymptomatic and did not spread the organism to other patients at the hospital. There is reportedly no cause for public concern.

NDM-1 can exist inside different bacteria, like E.coli, and it makes them resistant to one of the most powerful groups of antibiotics - carbapenems. These are generally reserved for use in emergencies and to combat hard-to-treat infections caused by other multi-resistant bacteria. At least one of the NDM-1 infections the Lancet researchers analysed was resistant to all known antibiotics.

Health officials should consider making NDM-1 reportable, says Dr. Susan Poutanen, a medical microbiologist and infectious disease physician at Mount Sinai Hospital in Toronto and author of the study. "We don't have a handle on the exact numbers because it's not currently tracked," she said.

The Public Health Agency of Canada recommends that patients identified as being infected with or colonized by NDM-1 should be treated in single rooms using contact precautions and enhanced environmental cleaning for the duration of their stay in hospital, as well as other steps. Dr. Poutanen reports that European guidelines recommend more precautionary steps.

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