the new superbug threat

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The New Superbug threat (NDM-1) - INTERNATIONAL HEALTH WARNING IS INDIA REALLY A BUG FACTORY, WRITES PROF. M S KHUROO World Health Organization (WHO) announced that Swine Flu H1N1 pandemic is over but announced a new global threat to human race. This time the threat is through a new bug (Bacterium). The bug is mysteriously or possibly mischievously named NDM-1 meaning New Delhi Metallo-beta- Lactamase-1 (NDM-1), pointing to the origin of the superbug from New Delhi. The controversy about this superbug started with the British investigators (Timothy Walsh from department of immunity, infection and biochemistry, department of medicine, Cardiff University) publishing a report in “Lancet Infectious Diseases”, a coveted British Journal. Uptill now the most dangerous bacterium which can infect humans and cause disaster has been named as MRSA, meaning Methicillin Resistant Staphylococcus Aureus. The bug (Staphylococcus aureus) is a common bacterium causing skin infections like boils and superficial wound infections. The bacterium is sensitive to penicillin antibiotic and easily treatable. Some of these bacteria produce an enzyme called penicillinase, which can destroy penicillin antibiotic. Such bacteria become resistant to penicillin antibiotics but can be easily treated with penicilinase-resistant penicillin’s which include Methicillin and its allied antibiotics. However, sometimes these bacteria produce enzymes which can destroy even Methicillin as well and thus become resistant to all penicillin family. MRSA are dangerous bugs and can infect newborns with high mortality, and devices like cardiac valves, pace makers etc with disastrous consequences. Many hospitals which do not follow strict infection control guidelines are potential sources of MRSA. Epidemic of MRSA have been reported to have originated from many such hospitals with disastrous human consequences. These bacteria need treatment with vancomycin, a toxic antibiotic, whose use needs close monitoring. The superbug NDM-1 is a new entrant to family of most dangerous bugs. These bacteria produce an enzyme called Metallo-beta-Lactamase-1 (MDM-

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Page 1: The New Superbug Threat

The New Superbug threat

(NDM-1) - INTERNATIONAL HEALTH WARNING

IS INDIA REALLY A BUG FACTORY, WRITES PROF. M S KHUROO

World Health Organization (WHO) announced that Swine Flu H1N1 pandemic is over but announced a new global threat to human race. This time the threat is through a new bug (Bacterium). The bug is mysteriously or possibly mischievously named NDM-1 meaning New Delhi Metallo-beta-Lactamase-1 (NDM-1), pointing to the origin of the superbug from New Delhi. The controversy about this superbug started with the British investigators (Timothy Walsh from department of immunity, infection and biochemistry, department of medicine, Cardiff University) publishing a report in “Lancet Infectious Diseases”, a coveted British Journal.

Uptill now the most dangerous bacterium which can infect humans and cause disaster has been named as MRSA, meaning Methicillin Resistant Staphylococcus Aureus. The bug (Staphylococcus aureus) is a common bacterium causing skin infections like boils and superficial wound infections. The bacterium is sensitive to penicillin antibiotic and easily treatable. Some of these bacteria produce an enzyme called penicillinase, which can destroy penicillin antibiotic. Such bacteria become resistant to penicillin antibiotics but can be easily treated with penicilinase-resistant penicillin’s which include Methicillin and its allied antibiotics. However, sometimes these bacteria produce enzymes which can destroy even Methicillin as well and thus become resistant to all penicillin family. MRSA are dangerous bugs and can infect newborns with high mortality, and devices like cardiac valves, pace makers etc with disastrous consequences. Many hospitals which do not follow strict infection control guidelines are potential sources of MRSA. Epidemic of MRSA have been reported to have originated from many such hospitals with disastrous human consequences. These bacteria need treatment with vancomycin, a toxic antibiotic, whose use needs close monitoring.

The superbug NDM-1 is a new entrant to family of most dangerous bugs. These bacteria produce an enzyme called Metallo-beta-Lactamase-1 (MDM-1). This enzyme destroys the most potent of the antibiotic, carbapenem, known to kill most of the known bacteria. 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 British investigators reported on 50 patients who were infected with the superbug. The superbug was named as New Delhi Metallo-beta-Lactamase-1(NDM-1) after the national capital (New Delhi), where a Swedish patient was reportedly infected after undergoing a surgery in 2008. Most of other patients had carried this infection from India, Pakistan and Bangladesh. 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

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44 patients in Chennai, 26 in Haryana, 37 in the UK and 73 in other places across India, Pakistan and Bangladesh. Based on these findings investigators commented: “NDM-1 is becoming more common in Bangladesh, India, and Pakistan and is starting to be imported back to Britain in patients returning from these countries. India provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide.”

NDM-1 superbug can be diagnosed when patient is infected with gram negative bacteria (sepsis) with culture report reported as resistant to all antibiotics. Such infections are commonly been reported in our hospitals but now has been named as above. Treatment options of such infections are limited. 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 MDM-1 enzymes are gram negative. Selection of antibiotic therapy should be tailored to antimicrobial susceptibility results for agents outside the beta lactam and carbapenem classes. In addition, antibiotic susceptibility testing should be requested for tigecycline, colistin and aztreonam.

However there may be more than what meets the eye in these reports! Indian surgeons rubbish the claim of superbug NDM-1 reports and contest that it's just another attempt to stop thousands of pounds from leaving the floundering British economy to boost healthcare in India. According to CII estimates, 1.1 million foreigners travel to India each year for cheaper treatments and surgeries. A heart bypass surgery costs $ 6,500 (R 3, 03,550) in a corporate hospital in India, as compared to $30,000 (R 14, 01,000) to $50,000 (R 23, 35,000) in the US. So convinced are British scientists about the superbug infection being fuelled by India's Rs 1,200-crore medical tourism industry that they have chosen to provocatively name the newly-identified gene that causes the drug resistance as the New Delhi Metallo-beta-lactamase (NDM-1). There are several comments passed by Indian Surgeons regarding these reports which include as follows: "It's a false alarm, I track infection and have not seen a single case in my hospital. Hospital-acquired infections are far more common in Britain and the West than in India," "We offer better surgical outcomes at one-fifth the cost, Most hospitals in India, including have national and international accreditations... who send auditors to track quality - including infections - four times a year. The audits show that corporate hospitals here are safer than the West. They're definitely safer than Britain's National Health Service."

Thus there is a major controversy surrounding these reports of the superbug NDM-1. How can this be sorted out and the significance of these reports validated? Indian researchers need to go on a war footing to look for these organisms in septic patients in primary, secondary and tertiary care hospitals. These protocols can be supervised by agencies like ICMR & NICD. Such reports if based on sound and dedicated protocols should be published in International journals with high impact factor and which undergo strict peer-review. Only after these reports are available, a true story of the superbug can be drafted. Till then, Western Govt:, Western media and WHO shall continue to raise the alarm and warn patients of Indian Superbug infections and its consequences if they choose to have surgeries done in Indian hospitals. Through this, there may be a serious threat to booming medical tourism to India.

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Outside these reports, we as physicians in India should look at ourselves including our healthcare. MRSA, NDM-1 and other infections in our hospitals do exist as in the West and can only be detected and controlled with strict infection control policies of each and every healthcare unit. In the West, each and every health unit has strict infection control policies of stringent nature. In fact the only policy a healthcare worker cannot break is that of infection control guidelines. This policy has several components which I might unravel some other time. Surgeons in Delhi-based tertiary-care hospitals have raised voice that such hospitals do follow infection control policies comparable to the Western standards and are being monitored by International agencies. However, I as a neutral person can vouch that no Indian hospital can reach the Infection control standards defined in the West. Let us assume that many such hospitals do adhere to such standards. What about hundreds and thousands of other primary and secondary care in India where these policies are not even introduced. Most of the patients which are being referred to such tertiary hospitals come from the grass root primary and secondary hospitals and this is/can be a major source of resistant bugs and superbugs to Apical/tertiary Institutions in which Western patients come for affordable surgeries. Thus if we have to face the West regarding Bugs and Superbug story we need to improve healthcare at grassroots level and introduce healthcare policies which are optimum and also monitored stringently. This shall go a long way in sustaining our medical tourism industry in future.

Bacteria Found That Kills Superbug

Friday, May 21, 2010 8:57 AM

A common bacteria found in the human nose and on skin which can cause diseases like meningitis and pneumonia can be destroyed by another bacteria found in the nasal passage, researchers have found.

The discovery may help experts find new ways to control the Staphylococcus aureus (S. aureus) bacteria, which has become more threatening in recent years because it has grown resistant to many powerful antibiotics.

One such strain is methicillin-resistant S. aureus (MRSA), a superbug that troubles doctors and public health experts because it is responsible for many infections that are hard to treat.

It is especially troublesome in hospitals where patients have open wounds, invasive devices, and weakened immune systems.

In a study conducted in Japan, the scientists examined 88 volunteers and found 60 of them did not carry S. aureus in their nasal cavities.

In an effort to find out why these 60 did not carry S. aureus, the researchers conducted further analysis that showed that they carried a subtype of Staphylococcus epidermidis (S. epidermidis),

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another bug which produces an enzyme that destroys S. aureus bacteria, they wrote in a paper published in Nature on Thursday.

"These findings indicated that in humans, the presence of inhibitory S. epidermis in the nasal cavity could be a potential determining factor for the absence of S. aureus colonization," wrote the team, led by Tadayuiki Iwase at the Jikei University in Tokyo, Japan.

Replying to questions from Reuters, Iwase said the enzyme destroyed multidrug-resistant strains such as MRSA.

This finding "could lead to the development of novel therapeutics to prevent S. aureus colonization and infection," he wrote.

About 20 percent of the human population are long-term carriers of S. aureus, which is often found in the nasal cavity.

The bacteria can cause minor illnesses, such as pimples and boils, to more serious diseases like meningitis, pneumonia, and septicemia. Once an infection takes hold it is very difficult to clear, especially when caused by drug-resistant strains.

UK doctors: New superbug gene could spread widely August 11, 2010 - 12:18 PMThe Associated Press

LONDON (AP) -- People traveling to India for medical procedures have brought back to Britain a new gene that allows any bacteria to become a superbug, and scientists are warning this type of drug resistance could soon appear worldwide.

Though already widespread in India, the new superbug gene is being increasingly spotted in Britain and elsewhere. Experts warn the booming medical tourism industries in India and Pakistan could fuel a surge in antibiotic resistance, as patients import dangerous bugs to their home countries.

The superbug gene, which can be swapped between different bacteria to make them resistant to most drugs, has so far been identified in 37 people who returned to the U.K. after undergoing surgery in India or Pakistan.

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The resistant gene has also been detected in Australia, Canada, the U.S., the Netherlands and Sweden. The researchers say since many Americans and Europeans travel to India and Pakistan for elective procedures like cosmetic surgery, it was likely the superbug gene would spread worldwide.

In an article published online Wednesday in the journal Lancet Infectious Diseases, doctors reported finding a new gene, called NDM-1. The gene alters bacteria, making them resistant to nearly all known antibiotics. It has been seen largely in E. coli bacteria, the most common cause of urinary tract infections, and on DNA structures that can be easily copied and passed onto other types of bacteria.

The researchers said the superbug gene appeared to be already circulating widely in India, where the health system is much less likely to identify its presence or have adequate antibiotics to treat patients.

"The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed," the authors wrote.

Still, the numbers of people who have been identified with the superbug gene remains very small.

"We are potentially at the beginning of another wave of antibiotic resistance, though we still have the power to stop it," said Christopher Thomas, a professor of molecular genetics at the University of Birmingham who was not linked to the study. Thomas said better surveillance and infection control procedures might halt the gene's spread.

Thomas said while people checking into British hospitals were unlikely to encounter the superbug gene, they should remain vigilant about standard hygiene measures like properly washing their hands.

"The spread of these multi-resistant bacteria merits very close monitoring," wrote Johann Pitout of the division of microbiology at the University of Calgary, Canada, in an accompanying Lancet commentary.

Pitout called for international surveillance of the bacteria, particularly in countries that actively promote medical tourism.

"The consequences will be serious if family doctors have to treat infections caused by these multi-resistant bacteria on a daily basis," he wrote.

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New antibiotic offers hope against “superbug”

Breaking the resistance: pseudomonas (blue) and a model of the new antibiotic (Zurich University) (unz)

Swiss scientists have found a new class of antibiotics which target a so-called hospital “superbug” – the multi drug-resistant and often deadly pseudomonas.

They hope that mechanism by which it works - which has never been seen before - could eventually be applied to other such bugs. Big pharmaceutical companies have already expressed an interest.

The joint research team from Zurich University and Swiss biotech company Polyphor has described the new drug class as a rare and significant step in antibiotics development.

Pseudomonas aeruginosa - what is known as a “gram-negative” bacterium - is one of the most common bugs found in hospitals. One feature of gram-negative bacteria is that the structure of their outer membrane protects them from many antibiotics.

Such bacteria account for an estimated 63 per cent of infections in hospital intensive care units. Experts have voiced fears that their resistance to antibiotics is rising.

“Pseudomonas is a severe problem for immune-compromised patients, such as those with severe burns, or lung infections like pneumonia, or people who are on ventilators,” team leader John Robinson, a professor of chemistry at Zurich University, told swissinfo.ch.

It also affects those suffering from the genetic disease cystic fibrosis, where the lungs are clogged with mucus and are unable to clear bacterial infections easily.

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“Eventually many of them die, not from the disease, but from the pseudomonas infection,” Robinson said.

New mechanism

There is thus an urgent need for new drugs in the fight against this type of bacteria. What makes the Swiss team’s development exciting is that it works in an entirely different way from conventional antibiotics.

Pseudomonas has a hard outer cell wall, making it difficult for a conventional antibiotic to penetrate it. What is more, if the antibiotic does manage the breach the cell’s defences, the bacterium uses a pump action to get rid of it.

“Our antibiotic actually hits a protein which is in the outer cell membrane, so it’s a sort of battering ram direct onto this essential protein machinery in the outer membrane, which is responsible for building the outer membrane,” explained Robinson.

“So we think that the antibiotic doesn’t have to get into the cell to act.”

Robinson said that it was quite rare for a completely new mechanism to be found in antibiotic research – it is believed that such events only happen every 20 years.

The results of the Swiss research were published in the February 19 edition of the renowned Science journal.

High interest

The clinical development of antibiotic is already being prepared, including Phase 1 clinical trials on healthy human volunteers.

“They are scheduled to start towards the end of the second quarter, so in summer this year,” Michael Altorfer, spokesman for Polyphor, which is based at Allschwil near Basel, told swissinfo.ch.

He confirmed that the company was already in talks with big pharmaceutical companies about developing the product, but for confidentiality reasons could not disclose any names at the moment.

“But the fact that already at this early stage big pharma partners are interested in negotiations shows that this discovery has been recognised,

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and the potential of these kind of molecules to be very valuable tools in the battle against this bacteria has been recognised,” Altorfer said.

However, it is likely to take some five to eight years for the antibiotic to come onto the market. It is hard to give a precise timescale, as this will depend on which patient group is targeted in Phase 2 trials – a decision most probably to be made by the pharma company developing the product, Altorfer explained.

Wider use

The antibiotic could eventually be administered in hospitals, the research team believes. Possible applications could be an inhaled form for cystic fibrosis patients, so that it would reach the lungs directly.

Robinson says that once more is understood about the new mechanism, it would in principle be possible to develop new compounds that could target other superbug bacteria.

This could include E.coli, which is also gram-negative, or the multi-resistant Acinetobacter baumannii which has been recorded in returning Iraq soldiers in both Britain and the United States and has proved difficult to treat.

But the antibiotic’s potential for treating pseudomonas is already clear. “It could be a significant step forward,” Robinson said.

Written by Anurupa Dash   

Saturday, 29 August 2009 16:03

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Superbug | Antibiotics | Health Threat

Antibiotics have been used to save millions of lives. These “miracle drugs” increased the life

expectancy of the patients and cured many from their sufferings.

Before the development of antibiotics, bacterial infections were a menace to cure. Increasing casualties

led the researchers to develop some remedy and antibiotics came into the scene. Penicillin was among

the first antibiotics used in the 1940s, to cure a wide variety of diseases. Gradually many antibiotics

were discovered. Carbapenems were developed in the 1980s to fight against gram negative bacteria

like Klebsiella, Pseudomonas, and Acinetobacter. Doctors started prescribing antibiotics for all types of

diseases even for viral diseases like coughs and sore throats. As a result bacteria developed resistance

to the widely used drugs.

Antibiotic resistance develops either due to natural selection or evolutionary stress on a bacterial

population. The bacteria transfer the resistant gene to others by plasmid exchange. A bacterium

carrying several resistance genes, is called multiresistant or, informally, a “superbug”. The misuse and

overuse of antibiotics has led to the rise of so-called “superbugs”. The World Health Organization has

named antibiotic resistance as one of three major health threats for the future.

Researchers from McGill and Oxford University have applied ecological and evolutionary theory to the

development of antibiotic resistant bacteria in hospitals. Their study suggests that, high rates of

immigration of bacteria into an environment containing antibiotics, introduces sufficient genetic

variation to cause the evolution of antibiotic resistance. This finding sheds light on the growing

incidence of highly antibiotic-resistant “superbug” bacteria such as Pseudomonas aeruginosa.

Fast mutating bacteria quickly adapt themselves to the antibiotic containing environment. The

evolutionary theory says that, “any population that adapts to cope with new challenges (such as

antibiotics), will limit its competitive ability against its predecessors in their original environment

(without antibiotics)”. But the “superbugs” are exceptionally adaptive to all kinds of environments

resulting in infections.

The antibiotic-resistant bacteria are generally addressed as ESKAPE bacteria, which includes

Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni,

Pseudomonas aeruginosa, and the Entero-bacter species.

Enterococci are equipped with naturally antibiotic resistant genes and are also capable of undergoing

mutation for gaining resistance to new antibiotics. They are highly resistant to Vancomycin and other

antibiotics such as Ampicillin, Aminoglycosides, Tetracycline, Rifampicin and Clindamycin. Vancomycin-

Resistant Enterococci (VRE) are an increasingly common cause of hospital-acquired infection and are

difficult to treat.

Doctors first identified methicillin-resistant Staphylococcus aureus (MRSA) in 1960s. The bacterium

Staphylococcus is known for its ability to develop resistance to most classes of antibiotics soon after

they enter widespread clinical use. MRSA carries a unique protein called ‘PBP 2a’ on the cell membrane

which plays key role in antibiotic resistance.

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Klebsiella are found in wide surroundings including humans, animals and even in water. The major

cause of infection is fecal contamination. These bacteria are resistant to almost all antibiotics hence are

generally termed as multiple antibiotic-resistant.

Acinetobacter is also a multiple antibiotic-resistant bacteria. In 2004 Tsunami, in Thailand, the patients

were infected with Acinetobacter which was even resistant to the antibiotic colistin.

According to the US Centers for Disease Control (CDC), the bacterium Pseudomonas aeruginosa is the

fourth most common pathogen found in hospitals. The toxins produced by these bacteria, called

‘biofilms’ are up to thousand times more resistant to antibiotics than the single bacterial cells. These

biofilms lead to chronic and long-term infections.

Entero-bacter species are resistant to Ampicillin, Amoxicillin, Amoxicillin-clavulanate, First-generation

Cephalosporins, and Cefoxitin owing to the production of constitutive AmpC Beta-lactamase. They are

one of the major causes of hospital-acquired pneumonia in patients during the early period of

mechanical ventilation.

Are new antibiotics successful against the “Superbugs”?

Scientists are working on new antibiotics that can provide defense against MSRA. They have identified

specific components of the bacterial cell wall which interact with PBP 2a. They are working on the

development of synthetic antibiotics based on Cephalosporin. These antibiotics will mimic the

components of the cell wall that co-operate with PBP 2a, leading to their deactivation and ultimately

destroying the bacteria.

The scientists tested these novel compounds against Vancomycin-resistant MRSA and found that they

successfully killed the bacteria. Phase I studies have been started for one of the compounds.

Among all, VRE and MRSA are the most dangerous and difficult to cure. Robert Hancock from the

University of British Columbia studied different proteins and short peptides to find out a molecule that

kill the VRE and MRSA. He and his colleagues studied different proteins and identified a 13-amino-acid

peptide, which they call an innate defense regulator (IDR-1). They tested the IDR-1 molecule in mice

infected with VRE, MRSA and Salmonella. The mice showed positive results with increased survival. The

IDR-1 molecule triggers the body’s innate immune response, due to which large amounts of monocytes

and macrophages are produced which destroys the bacteria.

Use of Nanotechnology

Dr Rachel McKendry and Professor Gabriel Aeppli from London Centre for Nanotechnology (LCN) are

working on the application of nanotechnology for finding a cure against the ‘superbugs’. They have

applied a silicon-based technology using cantilever sensors, which are less than the width of human

hair in size. These sensors are coated with a layer of mucopeptide on one side. When Vancomycin is

attached to the mucopeptide, a surface stress is created which is detected by the sensors. The surface

stress causes the disruption of the bacterial cell wall thereby destroying the ‘superbugs’.

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Resistant E.coli the next “Superbug”

E.coli have become resistant to commonly used antibiotics. They are the common cause of urinary tract

infections. The resistant strains have been observed to cause bloodstream infections in certain cases;

such infections are rare but in future they may become a threat to the patients and the physicians.

The Indian Scenario

In India the use of antibiotics is uncontrolled and over-the-counter availability of the drugs proves the

fact. Due to lack of any central monitoring agency, the situation of antibiotic resistance in India is

uncertain.

Disinfectants Create Mutant Superbugs

by Stephen Messenger, Porto Alegre, Brazil on 12.28.09

The manufacturers of cleaning products have made a lot of money convincing people that they are under constant assault from harmful bacteria. We've been told that the only way to keep our families safe and ensure good health is to disinfect, disinfect, disinfect! But, according to the latest research, all this superfluous disinfecting could be spawning mutant bacteria capable of resisting the strongest antibiotics. These superbugs have even the most unflappable of scientists doubling-up on their intensifiers:

"This is very, very worrying," says one researcher.

The research conducted by the National University of Ireland tested the bacteria Pseudomonas aeruginosa, which responsible for one out of every ten hospital-acquired infections. This strain is said to be "opportunistic" in that it typically affects those with immune systems already weakened.

A mutated strain of P. aeruginosa was observed developing a resistance to the common disinfectant benzalkonium chloride (BSK) with rapidly increasing tolerance. Eventually, the mutated superbug was able withstand concentrations of BSK 400 times greater than the non-mutated strain, according to a report in The Star.

But that's only the half of it.

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The superbug form of P. aeruginosa, which became resilient against BSK after prolonged exposure to the chemical, was also found to be resistance to the powerful antibiotic ciprofloxacin--despite never being exposed to it. Ciprofloxacin is considered a "drug of last resort" in fighting some of the world's scariest bacteria, such as anthrax. Researchers worry that if a bacteria strain more powerful than P. aeruginosa were to develop the resistance, the consequences could be devastating.

Another factor that has scientists wringing their hands is the dominance of the mutated strain over its non-mutated counterparts.

Dr. Gerard Fleming:

The organism that evolved outgrew all the other organisms. It means that a small amount of disinfectant will actually promote the growth of the organism. It's crossed that barrier.

What Can Stop These Superbugs?

According to the researchers, the overuse of disinfectants is to blame for the creation of these superbugs. Each time bacteria is exposed to diluted solutions of disinfecting chemicals like BSK, if its not killed, then each subsequent generation of the bacteria will be more resilant to the product.

Dr. Fleming:

We are without a doubt over-disinfecting. Not all bacteria are bad. I'm not saying don't use disinfectants. But they have to be used properly and in the right context.

The doctor was sure to differentiate the role of disinfectants in a hospital setting from that of the home. While it is important that hospitals be virtually bacteria-free, at home it's important to clean regularly, but "not the chair you sit in every day or the telephone or the doorknobs if you're a reasonably healthy person," according to Fleming.

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Fleming and the other researchers at the National University of Ireland plan to continue their studies in order to see if other bacteria have the potential to become superbugs as well. The current study will be published in the journal Microbiology