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Specialist warns against NDM-1 panic


The senior nurse at the centre of the global media panic over a rogue enzyme that renders infections “untreatable” has warned against excessive scaremongering.

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News of the risk posed by the New Delhi metallo-beta-lactamase-1 enzyme (NDM-1) broke last week after The Lancet Infectious Diseases journal detailed its global spread.

The enzyme changes the DNA of bacteria to make them immune to carbapenems - medicine’s last line of defence antibiotic.  The report also raised concerns at a lack of research into new medicines to combat emerging threats.

An NDM-1 case was treated earlier this year at North West London Hospitals Trust’s specialist intestinal and colorectal unit.

In spite of media headlines warning of a future where antibiotics will be useless, the trust’s director of infection control Fiona Coogan was at pains to stress the success of effective infection control work between nurses, doctors and microbiologists.

She said: “The patient was treated for a couple of weeks at St Mark’s Hospital and she is now at home alive and well. I don’t want to scaremonger or alarm people; I want to stress that this was a success story for her and for staff and other patients.”

“We are dealing with multiresistant organisms all the time such as multiresistant TB and multiresistant Acinetobacter. It’s all about stringent infection control measures which we have used to great success in combating MRSA and C difficile.”

The woman was admitted to Hillingdon Hospital in April after she arrived in the UK following stomach surgery in the Indian subcontinent. She was transferred to St Mark’s Hospital after being diagnosed with Klebsiella, a bacterium in the gut that is usually treatable, but that had mutated as a result of NDM-1 exposure.

Ms Coogan said the patient did not respond to last line antibiotics and when the Health Protection Agency confirmed the presence of NDM-1 the trust was advised to adopt the toughest barrier nursing methods.

The patient was treated with colonisation reduction therapy involving daily washes with anti-microbials.

Ms Coogan said everyone involved in the patient’s care was given a detailed briefing and nurses greeted the news in a very matter of fact way.

“Nobody was scared. We simply made it clear the steps that everyone had to follow. If you provide the right information people aren’t scared - it’s when you don’t give people enough information they get scared.”

How you can help protect people from NDM-1

The Department of Health has told Nursing Times nurses have a “key role” in protecting patients and the public from NDM-1. It says that in addition to guidance published by the HPA duties for nurses include:

  • Looking for evidence of travel or treatment in the Indian subcontinent when taking patient histories in general practice, specialist clinics or emergency settings
  • Advising patients attending travel clinics that if they travel to the Indian subcontinent they need to declare it to healthcare professionals if they are unwell on their return
  • Ensuring infection control measures are implemented promptly once cases or suspected cases have been identified
  • Aiming for a zero tolerance approach to healthcare associated infections as there is still scope to drive occurrence rates down further

HPA guidance is available at:


Readers' comments (3)

  • Perhaps we need to look at provision of antibiotics over the counter, this needs to be rethought as this would seem to be the major problem!

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  • once again the media takes over-look at the bloody millions wasted the last time 'experts' warned of a global pandemic

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  • This article is a good example of how the media often work against health care professionals by over hyping issues in health care. I agree with Ms Coogan in that it is important to not 'scaremonger and alarm' patients and staff. This case was clearly handled well by the trust mentioned, credit to them and their infection control team.

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