21 Oct 2010
They are likely to have caught the bug locally; more cases may surface
ANOTHER four people in Singapore have been infected by the new superbug, the highly drug-resistant New Delhi metallo-beta-lactamase 1 (NDM-1), bringing the total to six.
Of the latest cases, three were elderly patients aged between 74 and 94 but the fourth was in his 30s. As none of them had travelled abroad, it is likely that they had caught the bug locally.
The youngest patient may have acquired the superbug while in hospital as he developed a urinary tract infection after a two-month stay. The NDM-1 bacteria were not present in earlier tests done on the patient.
Health Minister Khaw Boon Wan cautioned that more such cases were likely to emerge, given the ease with which the NDM-1 gene can spread among bacteria.
The gene makes the bacteria resistant to many of the more common antibiotics.
Mr Khaw told The Straits Times that the NDM-1 “is already found in different species and strains of bacteria here”.
First detected in the Indian capital in December last year – hence its name – NDM-1 has been raising fears in many countries because bacteria with this gene are difficult to destroy.
An article in The Lancet Infectious Diseases journal last month concluded: “The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed.”
Cases have emerged in Britain, the United States, Europe and Australia, as well as in the Indian sub-continent.
Last month, it was reported that two people in Singapore had been infected by the superbug.
One was a patient who had received medical treatment in India and the other a Bangladeshi visitor who had come to Singapore for medical treatment.
Both were patients of the Singapore General Hospital (SGH) and were discovered when the hospital reviewed its old cases in the light of news about the superbug.
Of the recent cases, three were found to have NDM-1 at the Tan Tock Seng Hospital (TTSH) last month and the fourth was detected at SGH last week.
Four of the six have recovered, one is still in hospital and the last died “from unrelated causes”, said Mr Khaw.
He said all six patients suffered from other health problems that made them more susceptible to infection.
But he added that the bacteria found in the four latest cases were not the same as those reported in other countries or in the first two cases, and “were responsive to common antibiotics, despite having the NDM-1 gene”.
He said none of the infected patients posed a threat to public health.
To prevent more such bugs from emerging, he said, doctors must use antibiotics appropriately and implement stringent infection control. This includes isolating infected patients and strict hand hygiene for those dealing with patients.
Hospitals must also be vigilant and test all high-risk patients for NDM-1 and other drug-resistant bacteria.
Dr Lam Pin Min, chairman of the Government Parliamentary Committee for Health, told The Straits Times that he was pleased to hear that the ministry “is on top of the situation”.
But he added that Singapore’s push to become a medical hub exposed it to such risks.
“There are many social tourists or medical tourists arriving in Singapore and inevitably, many of them can be carriers of such superbugs,” he said. “The number of cases reported so far could well be just the tip of the iceberg.”
Mr Khaw also thinks the numbers will go up. “The ease of transfer of the NDM-1 gene between bacterial populations also makes it harder to contain its spread,” he said.
“Despite our best efforts, the NDM-1 gene may eventually become established in our bacterial populations as it is already found in different species and strains of bacteria here. We can therefore expect more cases.”
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Dept of Infectious Disease
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