A gene that makes bacteria resistant to even the most potent antibiotics may become the next global superbug to watch out for, warn British researchers.

New Delhi metalo-beta-lactamase (NDM-1), so named because of its origins in India, is becoming more prevalent in Bangladesh, India and Pakistan, according to a study published in the journal Lancet Infectious Diseases. The gene has also been imported to Britain by travelers, including "medical tourists" seeking cheaper treatments, such as cosmetic surgery, in South Asia.

The NDM-1 gene has resulted in "gram-negative enterobacteriaceae" that are highly resistant to most antibiotics, including carbapenems, the most potent class, write the study's authors. They conclude that NDM-1 has the potential to become "a worldwide public health problem, and coordinated international surveillance is needed" to combat it.

"Because of medical tourism and international travel in general, resistance to these types of bacteria has the potential to spread around the world very, very quickly," warns co-author Timothy Walsh, PhD, of Cardiff University in a published interview. "And there is nothing in the [drug development] pipeline to tackle it." The antibiotics colistin (which has toxic side effects) and tygecycline are 2 drugs known to fight carbapenem-resistant infections, experts say.

Health officials report there have been 3 cases of NDM-1 in the United States, all of which involved patients who had received medical care in India. Alexander Kallen, MD, of the Centers for Disease Control and Prevention says that carbapenem-resistant infections are not new to the U.S., although NDM-1 is. He says federal health officials consider this new mechanism for antibiotic resistance to be a "very high priority."

Irene Tsikitas

A major health system's move toward full disclosure of and compensation for medical errors has not brought on a flood of claims and litigation, but has actually decreased the time it takes to resolve patients' claims and lowered legal expenses, says a retrospective study.

The University of Michigan Health System launched its comprehensive claims management program in 2001 to seek out errors, report them to patients and compensate them when at fault, according to the study published in the Aug. 17 issue of the Annals of Internal Medicine.

"The need for full disclosure of harmful medical errors is driven by both ethics and patient safety concerns," says study co-author Allen Kachalia, MD, JD, of Brigham and Women's Hospital in Boston. "However, because of fears that disclosing every medical error may lead to more malpractice claims and costs, disclosure may not happen as often and consistently as we would hope."

An analysis of the health system's claims and costs from 1995 to 2007, however, shows a 61% decrease in legal defense expenses since the program was established. "This supports the possibility that patients may be less likely to file lawsuits when given prompt transparency and an offer of compensation," says Dr. Kachalia, and may encourage greater disclosure efforts across the healthcare field.

"This shows that over time, hospitals can afford to do the right thing," agrees co-author Richard C. Boothman, chief risk officer at the health system.

David Bernard

Researchers at the Georgia Institute of Technology say they have developed a protein coating that strengthens the bond between titanium joint replacement implants and bone, an advance that could lead to extended implant lifetimes and limit the need for revision surgeries.

By coating knee and hip implants with clusters of an engineered protein that mimics the body's own cell-adhesion material (fibronectin), the researchers have been able to create 75% more contact between the implant and surrounding bone than with the uncoated implants that are the current clinical standard for joint replacement surgery. In addition, the researchers say the coated implants hold in place more than twice as securely as the standard implants.

Clustering the engineered fibronectin pieces together creates an amplified signal for attracting receptors that attach to the fibronectin and directs enhanced bone formation around the implant, says Andres Garcia, a professor at Georgia Tech's Woodruff School of Mechanical Engineering and the Petit Institute for Bioengineering and Bioscience.

The researchers note that close to 40% of the 712,000 total hip and knee replacements performed in 2004 were done on patients between 45 and 64 years of age. Since the standard implants used for these procedures typically last 15 years, the younger joint replacement patients must often endure a second procedure to have deteriorating hardware replaced.

Improving the lifetime of the titanium joints and creating a better connection with the bone therefore becomes extremely important, they explain, adding that their study "establishes that a material-based strategy in which implants are coated with clustered bioadhesive ligands can promote robust implant-tissue integration."

Daniel Cook

If you or a member of your family required elective surgery, where would you opt to have it done? At your own facility, where you know the doctors, the staff and the quality of care you'd receive? Or at another facility, where you're just another patient? Let us know and see instant results on our online poll, then check back next week for the final tally.

Last week's InstaPoll asked if you've ever used a single-dose medication vial multiple times. More than three-fourths (77%) of our 190 respondents admitted that they had, in clear violation of infection control guidelines.

Dan O'Connor