International travel and medical tourism helped the spread of drug resistant bacteria that could lead to the end of antibiotics, scientists have warned.
A new gene, NDM-1 (New Delhi metallo—lactamase), emerged which allows bacteria to be highly resistant to almost all antibiotics, the scientists said.

NDM-1 spread in India, Pakistan, and Bangladesh.  But it was also found in 37 patients from the UK, who travelled to India or Pakistan for medical procedures including cosmetic surgery, according to an article published in The Lancet.

“The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed,” Timothy Walsh of Cardiff University and his international colleagues wrote.

The gene was mostly found in E Coli, a common cause of urinary tract infections and pneumonia, which is highly resistant to antibiotics.

The authors said it could be easily copied and transferred between different bacteria, suggesting “an alarming potential to spread and diversify among bacterial populations”.

The paper said several of the UK patients had travelled to India or Pakistan for surgical procedures within the past year.

They wrote: “India also provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide.”

Study co-author Dr David Livermore, director of antibiotic resistance monitoring at the Health Protection Agency, said: “The findings of this paper show that resistance to one of the major groups of antibiotics, the carbapenems, is widespread in India.

“This is important because carbapenems were often the last ‘good’ antibiotics active against bacteria that already were resistant to more standard drugs.

“We have now also identified bacteria with this type of resistance – NDM – in around 50 patients in the UK.  Most, not all, had previously travelled to the Indian subcontinent, and many had received hospital treatment there.”

“International travel gives a great potential for spread of resistant bacteria between countries.  Few antibiotics remain active against these bacteria. Their spread underscores the need for good infection control in hospitals both in the UK And overseas, and the need for new antibiotic development.”

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.

“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.”

From: http://www.independent.co.uk/new-superbug-spreads-to-uk-hospitals

HIV infections among the over 50s have more than doubled in seven years.
The number of new cases per year recorded in England, Wales and Northern Ireland rose from 299 to 710 between 2000 and 2007, research has shown.

Half were diagnosed late, increasing the risk of an early death from Aids.

Among younger age groups, a third have the HIV infection identified at a similar level of progression.

During the study period, three quarters of deaths among HIV-infected people aged 50 and over occurred within a year of diagnosis.

Compared with younger adults carrying the virus, older people were significantly more likely to have been infected through sex with men.

Older “straight” adults were more likely to acquire the virus in the UK, but there was evidence of white heterosexual men picking up the infection abroad.

Ruth Smith, a senior HIV scientist at the Health Protection Agency’s Centre for Infections, said: “We estimate that nearly half of older adults diagnosed between 2000 and 2007 were infected at age 50 or over and this highlights the importance of HIV testing – whatever your age.

“We must continually reinforce the safe sex message – using a condom with all new or casual partners is the surest way to ensure people do not become infected with a serious sexually transmitted infection such as HIV.”

The findings are published online in the journal AIDS and were presented today at the International Aids Conference in Vienna.

HPA data shows there are more than 83,000 people in the UK living with HIV, a quarter of whom do not know they are infected.

In 2008 there were 7,382 new HIV diagnoses in the UK with an estimated 32% over the age of 15 being diagnosed late.

A late diagnosis of HIV infection is defined as having a CD4 white blood cell count of less than 200 cells per cubic millimetre of blood. Healthy individuals have CD4 counts of 500 and above.

CD4 cells are a key part of the immune system. When their numbers fall too low, a person becomes vulnerable to infection.

Study co-author Valerie Delpech, head of HIV surveillance at the HPA, said: “Although adults aged 50 and over account for just 8% of all new HIV diagnoses, the fact that cases have more than doubled in recent years serves as a timely reminder that anybody is at risk of HIV infection if they do not use protection and practise safe sex.

“HIV remains a serious infection particularly when diagnosed late. The fact that we’ve seen an increase in the number of older adults getting diagnosed, and in particular getting diagnosed late, highlights the need for raised awareness in that age group.”

“Medical guidelines issued in 2008 encouraged widespread testing in areas where there is a high prevalence of HIV and the HPA fully supports any NHS or charity organisation initiative which will encourage increased testing and increased offering of testing across the UK.”

From: http://www.independent.co.uk/hiv-infection-rate-in-over-50s-doubles

Women should be tested for chlamydia every time they have a new sexual partner to cut their chances of pelvic disease, UK researchers say.

A study of 2,500 students found that annual screening is not enough to prevent cases of pelvic inflammatory disease, which can cause infertility.

In those who were found to have chlamydia, treatment cut the risk of pelvic disease by 80%.

The National Chlamydia Screening Programme backed the findings.

The researchers from St George’s, University of London, concluded that most cases of pelvic inflammatory disease were in women who did not have chlamydia when they were tested a year earlier.

The findings, published in the British Medical Journal, suggested they may have become infected in the 12 months after screening.

Chlamydia is the most common sexually transmitted disease in the UK and the number of cases is steadily rising.

The researchers recruited sexually active female students between the ages of 16 to 27 from 20 universities and colleges in London.

They were swabbed at the beginning of the study and tested for pelvic inflammatory disease, which as well as infertility can cause chronic pain and increase the risk of ectopic pregnancy, a year later.

The researchers found that most cases of pelvic inflammatory disease occurred in women who tested negative for chlamydia when they were initially tested.

Study leader Professor Pippa Oakeshott, who also works as a GP, said: “The crucial message is that individuals should get tested every time they have a new sexual partner.”

But she added that chlamydia was not the only cause of pelvic inflammatory disease.

“It’s probably several bacteria that cause it, and we should probably be screening for other things, but chlamydia and gonorrhoea is a good start.”

She also said testing needed to be more accessible to young people, with kits being given out in colleges and youth clubs.

A spokesman for the Health Protection Agency said the findings reinforced the testing policy of the National Chlamydia Screening Programme, which was launched in 2003.

“The study, looking at a single annual test, shows the importance of the programme’s approach to testing annually or on change of sexual partner because most cases of pelvic inflammatory disease occurred in women who initially tested negative for chlamydia.”

Last year the National Audit Office criticised the screening programme for duplicating effort and failing to test as many of the under-25 target group in England as it should have.

From: http://news.bbc.co.uk/1/hi/health/8609354.stm