Recently we suffered a pandemic of Swine flu due to H1N1 Virus ,previous to it an Avian flu but now our Capital is adding a new Pandemic to world as  threat of NDM-1 Bacteria,originating from New Delhi, Called New Delhi Metallo-beta-Lactamase-1, is a new Superbug identified by the researchers and is resistant to all known antibiotics.  These are not being killed by modern Carbopenams (meropenam) and other Beta Lactamase Inhibitors (Tazobactum,sulbactum,pipercillin) as a result more infection to wounds will come to a normal patients in our hospital and those compromised like diabetics, suffering from cancer, HIV, getting, immunosupressants for transplants, immunological disorders, on steroid, cancer chemotherapy, elderly and childrens.

Lancet Infectious disease journal reports 50 such cases. Most of them have carried this infection from India, Pakistan and Bangladesh. The superbug NDM-1 is named after the national capital, where a Swedish patient was reportedly infected after undergoing a surgery in 2008. It is much more dangerous than the notorious MRSA infection. MDM-1 is an enzyme produced by certain bacteria, which allows them to neutralize the harmful effects of carbapenem one of the most powerful types of antibiotics. Currently no new types of antibiotics are in the development pipeline that will be effective against it. Enzymes such MDM-1 are produced by strands of DNA which bacteria are known to transfer between one another. Currently E Coli and Klebsiella Pneumoniae are the two bacteria who are host to MDM-1. What makes the superbug more dangerous is its ability to jump across different bacterial species. The superbug has the potential to get copied and transferred between bacteria, allowing it to spread rapidly. If it spreads to an already hard-to-treat bacterial infection, it can turn more dangerous.The current treatment option is to treat them with a cocktail of antibiotics. Most new antibiotics currently under development are effective only against gram positive bacteria like super bug MRSA. Unfortunately, bacteria that carry the NDM-1 enzymes are gram negative.

A joint study was led by Chennai- based Karthikeyan Kumarasamy, pursuing his PhD at University of Madras and UK-based Timothy Walsh from department of immunity, infection and biochemistry, department of medicine, Cardiff University. They found the bug in most of the hospitals in Chennai and Haryana with estimated prevalence of this infection 1.5%. They reported the superbug in 44 patients in Chennai, 26 in Haryana, 37 in the UK and 73 in other places across India, Pakistan and Bangaladesh. gram negative sepsis with culture report: resistant to all antibiotics. We have been seeing such cases in the last few years. Now we have a name for this disease. Many of the doctors are deying its existance and linking it to a move against medical tourism in India. But the ICMR, NICD should work on it and come out with guidelines for this infection as no one can deny the fact that we do see cases of gram negative sepsis with E Coli or Klebsiella with culture report resistant to all antibiotics.

Carbapenemases are carbapenem - hydrolyzing beta - lactamases that confer carbapenem resistance. while Class B enzymes require the presence of zinc for activity (and hence are referred to as metallo- beta- lactamases). Class B beta-lactamases: are also known as the metallo- beta- lactamases (MBLs), which are named for their dependence upon zinc for efficient hydrolysis of beta-lactams. As a result, MBLs can be inhibited by EDTA (an ion chelator), although they cannot be inhibited by beta- lactamase inhibitors such as tazobactam, clavulanate, and sulbactam.
Acquired MBLs consist of genes encoded on integrons residing on large plasmids that are transferable between both species and genera. In a hospital outbreak involving 62 patients (including 40 intensive care unit patients), for example, an MBL gene (bla IMP-4) spread among seven different gram-negative genera (Serratia, Klebsiella, Pseudomonas, Escherichia, Acinetobacter, Citrobacter, and Enterobacter). Laboratory detection of MBL- producing organisms can be especially difficult if the organisms carry "hidden" MBL genes; The MBL E-test (a commercially available assay) cannot consistently identify MBL- producing organisms that are truly resistant to carbapenems. Therefore, MBL- producing organisms should be considered carbapenem- resistant regardless of carbapenem susceptibility results.

Other identification methods take advantage of the zinc dependence of MBLs by using EDTA, which chelates the zinc. Combination disc tests using imipenem and EDTA discs or using two carbapenem discs (including one with EDTA incorporated) have been reported. A more sensitive MBL detection method uses an agar plate with three components: a double disc synergy test with imipenem and EDTA discs, a combined disc test comprising two imipenem discs (with one disc also containing EDTA), and an aztreonam disc to detect aztreonam susceptibility. Carbapenem susceptible isolates that are resistant to both ceftazidime and ticarcillin- clavulanate should be considered for MBL testin Genotypic identification using PCR amplification with primers specific for MBL genes (eg, blaVIM or blaIMP) is an accurate method for the detection of MBL- producing organisms. (Source uptodate)