Despite WA leading the world in battling the superbug MRSA (methicillin-resistant Staphylococcus aureus) and leading Australia in keeping in check the bacteria VRE (vancomycin-resistant enterococci), microbiologist Keryn Christiansen remains concerned that the State could be doing more to guard against dangerous emerging multi-antibiotic-resistant E.coli and klebsiella.
These are the bowel bugs gaining immunity to the drugs used to fight them that have caused havoc in India and Europe.
With the popularity of long-distance travel and medical tourism, including overseas trips for cosmetic surgery and transplants, she predicts it will not be long until they are on WA’s doorstep.
In preparation, she believes Australia’s current surveillance system, which involves only an “annual snapshot” of antibiotic- resistant E.coli and klebsiella, needs to be upgraded to continuous monitoring within the State, including epidemiologically typing in order to inform public health action. A similar, much more thorough, monitoring system had already proved effective in keeping MRSA and VRE in check in WA.
In an environment where E.coli and klebsiella were picking up a lot of resistance genes making them more and more difficult to treat, current efforts were not enough, she said. Already from the Indian subcontinent had come “really nasty” forms, with antibiotic- resistance genes located on mobile elements – a moving snippet of DNA – with the potential to jump to other strains.
Alarm bells began ringing in the medical community with the discovery of a gene called NDM-1, (New Delhi metallo–lactamase-1), which passes easily between E.coli and klebsiella and makes them resistant to almost all of the powerful, newer generation, last-line group of antibiotics called carbapenems.
Then in April, it was announced that disease-causing bacteria carrying this new genetic resistance to antibiotics, NDM-1, had been discovered in New Delhi’s drinking water supply.
The finding was made by a Cardiff University-led team and there were estimates that 500,000 New Delhi residents may be carrying the NDM-1 resistance gene in their gut flora. Then reports began coming in of infections already appearing in patients in Australia, in Europe, North America and other parts of Asia.
Adding to the disease burden, recent newspaper reports have been focusing on warnings of another deadly E.coli bacterium, the O104:H4 strain that has continued to spread around the world from its source in northern Germany. It is also resistant to several antibiotics, although the toxin it produces is the major health threat.
Originally Spanish cucumbers were wrongly blamed as the source of this outbreak.
“We have already had NDM-1 on the east coast,” Professor Christiansen said. “We have not had one yet in Perth, but it will come because we do have a lot of people going to the subcontinent for medical tourism. They go there for their transplants, they go there for their cosmetic surgery, and they will bring it back.
“Obviously travellers will too. There was a recent journal article that showed it was in the drinking water in India.
“So travellers will start to bring these sorts of organisms into the country and we will start to see more and more of these and it is going to make treatment really difficult. And now in WA, we don’t have any kind of real surveillance to know what is happening.”
Based at Royal Perth Hospital, considered an expert in the field and given the role of examining all local isolates of superbugs, Professor Christiansen was a main speaker at Australia’s “call to urgent action” Antimicrobial Resistance Summit in February, held