2010年08月12日08:59
來源：《新京報》
一名英國醫學研究人員正在進行實驗。研究者最近發現一種可以讓病毒抵御幾乎所有抗生素的“超級病菌”。資料圖片抗生素是人類抵御細菌感染類疾病的主要武器。但是，最近，這種武器遭到巨大挑戰。醫學權威雜志《柳葉刀》11日刊登的一篇論文警告說，研究者已經發現一種“超級病菌”，它可以讓致病細菌變得無比強大，抵御幾乎所有抗生素。目前，這種“超級病菌”已經從南亞傳入英國，並很可能向全球蔓延。
一種超強的?
這項研究由英國卡迪夫大學、英國健康保護署和印度馬德拉斯大學的醫學研究者聯合進行。研究人員稱，他們在一些赴印度接受過外科手術的病人身上找到一種特殊的細菌，這種細菌含有一種?，它能存在於大腸杆菌等不同細菌DNA結構的一個線粒體上，並讓這些細菌變得威力巨大，對幾乎所有的抗生素都具備抵御能力。
去年，卡迪夫大學的研究者蒂莫西沃爾什首次在一名瑞典病人感染的大腸杆菌和肺炎杆菌中確認了這種?的存在，並將之命名為NDM-1。
已有致死病例
研究者發現，2009年英國就已經出現了NDM-1感染病例的增加，其中包括一些致死病例。參與這項研究的英國健康保護署專家大衛利弗莫爾表示，大部分的NDM-1感染都與曾前往印度等南亞國家旅行或接受當地治療的人有關。
而研究者在英國研究的37個病人中，至少有17人曾在過去1年中前往過印度或巴基斯坦，他們中至少有14人曾在這兩個國家接受過治療，包括腎臟移植手術、骨髓移植手術、透析、生產、燒傷治療或整容手術等。不過，英國也有10例感染出現在完全沒有接受過任何海外治療的病人身上。
目前的研究發現，攜帶NDM-1的大腸杆菌感染，會導致許多病人出現尿路感染和血液中毒。一部分感染者病情較為緩和，但也有一些人較為嚴重。在已發現的NDM-1細菌感染病例中，至少有一例已經對所有已知的抗生素具有抗藥性。
英政府發警告
類似的NDM-1感染也出現在了美國、加拿大、澳大利亞和荷蘭。盡管目前在英國隻發現了約50例病例，但科學家們擔心它還會繼續蔓延。沃爾什說，現在還無法確定NDM-1在英國到底蔓延到什麼程度。英國衛生部已就此發出警告。
“由於頻繁的國際航空旅行、全球化以及南亞國家醫療旅游業的興起，NDM-1現在有機會迅速傳播到世界的任何一個角落。”沃爾什警告說。（馬晶）
■ 名詞
抗生素
抗生素是微生物的代謝產物或合成的類似物，能抑制微生物的生長和存活，而對宿主不會產生嚴重的副作用。
抗生素基本上可分為二大類，一為抑制病原的生長，二為直接殺死病原。可用於治療大多數細菌感染性疾病﹔抗生素的主要來源是發酵，也可以通過化學合成和半合成方法制得。
發現並應用抗生素是人類的一大革命，它成為人類同死神抗爭的一大武器，因為人類死亡的第一大殺手就是細菌感染。（宗禾）
http://scitech.people.com.cn/BIG5/12417444.html
擊退所有抗生素 新超級病菌恐蔓延
(明報)2010年8月12日 星期四 05:10
【明報專訊】英國 近期發現50名曾到南亞接受整容或其他手術的病人，證實感染新型超級細菌，可抵抗幾乎所有抗生素，感染者幾近無藥可醫。有關細菌能夠如此強勁，關鍵是帶有名為NDM-1的新發現基因。由於NDM-1基因可在不同種類的細菌之間轉移、令到該種細菌變得極具抗藥性，專家擔心帶有這種基因的超級細菌，會蔓延全球。
50人南亞整容受感染
歐美人士近年流行到印度 或巴基斯坦整容隆胸，原因是費用便宜。但英國卡迪夫大學的研究員沃爾什（Timothy Walsh），去年首次在一名曾到印度接受手術的瑞典 病人身上，發現攜有NDM-1基因的克雷伯氏肺炎菌（Klebsiella pneumoniae）和大腸桿菌（Escherichiacoli）。由於NDM-1基因是在可以輕易複製轉移的DNA結構上發現，使其具有驚人的擴散和引致變異潛力。研究員警告，航空運輸已令這些細菌基因，悄悄在不同國家以至大陸之間迅速轉移。
NDM-1基因可輕易轉移
研究員最近調查了帶有NDM-1基因的超級抗藥病菌，在南亞和英國的普遍程度，在印度欽奈（Chennai）向病人進行抽查，發現44例，佔抽查個案1.5%；在印度哈里亞納邦（Haryana）則發現26例，佔抽查個案8%，在孟加拉和巴基斯坦亦發現病例。英國則發現50宗，患者最近都曾到南亞接受整容或其他手術。研究報告稱：「印度亦為其他歐洲和美國 人提供整容手術，NDM-1很可能會蔓延全球。」
帶有NDM-1基因的病菌，連碳青黴烯類（carbapenems）抗生素都可抵抗，而這類抗生素已常被用作對付嚴重抗藥性細菌的最後武器。研究員沃爾什不諱言當前情况嚴峻，「我們幾乎沒抗生素可用」。
研究員警告，NDM-1基因屬Gram-negative，現時只有少數新的Gram-negative抗生素在開發中，但全部對NDM-1基因無效，有可能預示了抗生素時代的終結。
英國廣播公司 /法新社/太陽報
http://hk.news.yahoo.com/article/100811/4/jn7q.html
英美發現新超級病毒基因
(商台)2010年8月12日 星期四 08:02
英美相繼發現一隻相信來自印度 及巴基斯坦的新超級病毒基因。外國專家警告，由於越來越多人，去收費較低的印度接受治療及整容，這種幾乎對所有藥物出現抗藥性的病毒基因，可能很快散播全球。
負責研究的英國 科學家說，有關病毒基因普遍發現於印度，巴基斯坦及孟加拉。英國至今收到大約五十宗個案，美國 亦有三宗。專家警告，超級病毒基因可以存在於不同細菌，例如大腸桿菌。基因對目前最有效的抗生素，亦都出現抗藥性。
http://hk.news.yahoo.com/article/100812/18/jncx.html
'超級病菌'警報如抗藥性基因打擊英國
'Superbug' Alert As Resistant Gene Hits UK
11:07am UK, Wednesday August 11, 2010
Carole Erskine, Sky News Online
A 'superbug' that is resistant to the most powerful antibiotics has reached the UK.
The 'superbug' can live inside E.coli (above) and trigger further infections
'超級病菌'可以活在大腸桿菌內（上），及引發進一步感染
Scientists are warning the bug, an enzyme called New Delhi-Metallo-1 (NDM-1), could spread across the world as nothing is being developed to treat it.
There has been 37 reported cases in the UK, mainly among patients who travelled to areas of Asia for cosmetic surgery, transplants and cancer treatment.
The bug can exist inside different bacteria, like E.coli, and cause infections in other parts of the body.
The potential for wider international spread and for NDM-1 to become endemic worldwide are clear and frightening.
更廣泛的國際傳播潛質，和NDM-1成為全世界大流行是明確和可怕的。Dr David Livermore, reseacher
It can also move from one bacterium to another and experts are concerned it may attach itself to more dangerous diseases and cause them to become resistant to antibiotics.
The scientists, writing in the journal Lancet Infectious Diseases, said: "It has an alarming potential to spread and diversify."
Dr David Livermore, one of the researchers and who works for the UK's Health Protection Agency (HPA), said: "The NDM-1 problem is likely to get progressively worse in the foreseeable future.
"The potential for wider international spread and for NDM-1 to become endemic worldwide are clear and frightening."
Infections have already been passed from patient to patient in UK hospitals.
Researchers say the way to stop NDM-1 is to identify and isolate any patients who are infected.
A Department of Health spokesman said: "We are working with the Health Protection Agency on this issue.
"The HPA alerted the NHS in January and July last year to be vigilant about these bacteria and take appropriate action where necessary.
"Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.
"The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues."
http://news.sky.com/skynews/Home/UK-News/Superbug-Enzyme-New-Delhi-Metallo-1-Detected-In-UK-Hospitals-Is-Resistant-To-Antibiotics/Article/201008215681024
新的'超級病菌'被發現在醫院
New 'superbug' found in UK hospitals
By Michelle Roberts
11 August 2010 Last updated at 13:14 GMT
Health reporter, BBC News
A new superbug that is resistant to even the most powerful antibiotics has entered UK hospitals, experts warn.
一種新的超級病菌，那是對甚至是最強力的抗生素抗藥性的，已進入英國的醫院，專家警告。
They say bacteria that make an enzyme called NDM-1 have travelled back with NHS patients who went abroad to countries like India and Pakistan for treatments such as cosmetic surgery.
Although there have only been about 50 cases identified in the UK so far, scientists fear it will go global.
Tight surveillance and new drugs are needed says Lancet Infectious Diseases.
NDM-1 has been found in E.coli bacteriaNDM-1 已被發現在大腸桿菌中的細菌
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.
And experts fear NDM-1 could now jump to other strains of bacteria that are already resistant to many other antibiotics.
Ultimately, this could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.
At least one of the NDM-1 infections the researchers analysed was resistant to all known antibiotics.
Similar infections have been seen in the US, Canada, Australia and the Netherlands and international researchers say that NDM-1 could become a major global health problem.
Infections have already been passed from patient to patient in UK hospitals.
NDM-1感染熱點
The way to stop NDM-1, say researchers, is to rapidly identify and isolate any hospital patients who are infected.
研究人員說阻止NDM- 1的方法，是迅速查明和隔離任何受到感染的醫院病人。
Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.
And currently, most of the bacteria carrying NDM-1 have been treatable using a combination of different antibiotics.
But the potential of NDM-1 to become endemic worldwide is "clear and frightening", say the researchers in The Lancet infectious diseases paper.
The research was carried out by experts at Cardiff University, the Health Protection Agency and international colleagues.
Dr David Livermore, one of the researchers and who works for the UK's Health Protection Agency (HPA), said: "There have been a number of small clusters within the UK, but far and away the greater number of cases appear to be associated with travel and hospital treatment in the Indian subcontinent.
"This type of resistance has become quite widespread there.
"The fear would be that it gets into a strain of bacteria that is very good at being transmitted between patients."
He said the threat was a serious global public health problem as there are few suitable new antibiotics in development and none that are effective against NDM-1.
The Department of Health has already put out an alert on the issue, he said.
"We issue these alerts very sparingly when we see new and disturbing resistance."
外遊記錄
Travel history
The National Resistance Alert came in 2009 after the HPA noted an increasing number of cases - some fatal - emerging in the UK.
The Lancet study looked back at some of the NDM-1 cases referred to the HPA up to 2009 from hospitals scattered across the UK.
At least 17 of the 37 patients they studied had a history of travelling to India or Pakistan within the past year, and 14 of them had been admitted to a hospital in these countries - many for cosmetic surgery.
For some of the patients the infection was mild, while others were seriously ill, and some with blood poisoning.
A Department of Health spokeswoman said: "We are working with the HPA on this issue.
"Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.
"So far there has only been a small number of cases in UK hospital patients. The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues."
The Welsh Assembly Government said it would be "fully considering" the report.
"The NHS in Wales is used to dealing with multi-resistant bacteria using standard microbiological approaches, and would deal with any new bacteria in a similar way," said a spokesperson.
http://www.bbc.co.uk/news/health-10925411
問與答：NDM-1 - 超級病菌
Q&A: NDM-1 superbugsBy Michelle Roberts
11 August 2010 Last updated at 02:24 GMT
Health reporter, BBC News
NDM-1 is carried by Gram-negative bacteria like KlebsiellaExperts have warned that a new type of drug-resistant superbug is emerging in UK hospitals.
Q: What is NDM-1?
New Delhi metallo-ß-lactamase-1, or NDM-1 for short, is a gene carried by bacteria that makes the strain resistant to carbapenem antibiotics. This is concerning because these antibiotics are some of the most powerful ones, used on hard-to-treat infections that evade other drugs.
Q: Why is this a problem?
NDM-1 (or more precisely the DNA code for this enzyme) can easily now jump from one strain of bacteria to another.
Experts are worried that it may end up in another bacterium which is already resistant to many other antibiotics.
Ultimately, it could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.
Q: Can it be treated?
Other treatment options are available to fight these infections but they present major challenges for clinicians and will often demand combinations of antibiotics are used.
Scientists have identified some strains that have been resistant to all known antibiotics.
Q: How would I know if I had it?
So far, many of the UK cases have been in patients who have recently travelled to India or Pakistan for medical treatment and who caught the infection while there.
But, some of these patients have passed the infection on to others in UK hospitals upon their return.
The infections have ranged from mild to severe - and some have been fatal.
Two types of bacteria have been host to NDM-1: the gut bacterium E.coli and another that can invade the lungs called Klebsiella pneumonia. Both can lead to urinary tract infections and blood poisoning.
Infections such as these would usually be spotted in patients by medics.
Q: Can its spread be stopped?
Experts say the way to stop it is through surveillance, rapid identification and isolation of any hospital patients who are infected.
Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.
NDM-1 is already widespread in the Indian subcontinent and has also reached countries including the US, Canada, Australia and the Netherlands. Scientists believe it has the potential to become a global public health issue.
And they say we now need new drugs to treat resistant strains.
Q: Are there new antibiotics that could help?
While there is a great deal of investment in research to find new antibiotics, experts say that most of the drugs currently in the pipeline will be useless for treating NDM-1 positive patients.
This is because the bacteria that carry NDM-1 are Gram-negative, while most of the work is being carried out for Gram-positive bugs like MRSA.
The Health Protection Agency says "multi-resistant Gram-negative bacteria pose a notable public health risk and it remains important that the pharmaceutical industry continues to work towards developing new treatment options".
The Department of Health said it was investigating ways of encouraging the development of new antibiotics with European colleagues.
Q: What will happen now?
The government said HPA would continue to monitor the situation and would regularly review the data and the need for further action.
In the meantime, hospitals should ensure they continue to provide good infection control to prevent any spread, and consider whether patients have recently been treated abroad and send samples to HPA for testing if necessary
http://www.bbc.co.uk/news/health-10930031
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