Superbug spreads and takes root: 9 cases of locally-acquired NDM-1 infection in South Africa

Oct 18, 2011 | Glory Song | Outbreak News

Nine patients have been infected with the highly antibiotic-resistant, NDM-1 containing bacteria, commonly known as a superbug, at the Life Glynnwood Hospital in Benoni, South Africa. Of these individuals, four have been discharged, three are still under quarantine, and two have died. The two patients who died were admitted with underlying chronic conditions, which severely increases the risk of infection and death. Only two other cases of NDM-1 had been reported in South Africa recently.

NDM-1 is found in E.coli and K.pneumoniae, two bacteria that may remain harmless while in the gut but become highly pathogenic and even lethal once they spread into the bloodstream or urinary tract, potentially causing urinary tract infections, blood poisoning, and pneumonia.

NDM-1 was first identified in late 2009 and identified in patients who had gone to India, Pakistan and Bangladesh where medical care and procedures are much more affordable, in a phenomenon dubbed “medical tourism.” Strong resistance most likely arose from improper use and overuse of antibiotics in these less developed healthcare settings (Healthmap first reported on NDM-1 in August 2010 and later followed up with a drug resistant bug overview). However, the current cases in South Africa are found to have been from secondary infections - these patients have never been to India, Pakistan or Bangladesh and were instead infected by carriers of the bacteria within their own country, an indication of the pathogen’s increasing prevalence. The exact local source of infection has not yet been identified for this outbreak.

In response to the outbreak, all patients admitted to the hospital’s ICU will be screened and doctors will review patients who have been receiving antibiotics for more than five days. The outbreak was quickly identified as a result of public health monitoring efforts by the National Institute for Communicable Diseases (NICD) and the capacity for diagnosis by labs funded by the private sector. The hospital is currently using Tigecycline and Colistin, two antibiotics, to fight the infections.

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