BREAKING NEWS You Can Use Boston hospitals say they’re ready for “We observed that the majority of elevator buttons were colo- nized by bacteria that were not pathologic in most cases — but the Ebola cases overall prevalence rate exceeded toilet surfaces.” In response to the West African outbreak of the deadly Ebola virus, some Sixty-one percent of the elevator buttons they tested were colonized Boston hospitals are instructing clinical staff to ask patients as soon as with bacteria, compared to 43 percent of the toilet surfaces tested. In the they arrive about their travel histories, and reminding doctors and nurs- bathrooms, the surfaces tested were the door handles on the inside and es of the symptoms. But hospital officials say they would be ready to outside of the main door, the privacy latch and the toilet flusher. n quickly identify the illness and prevent its spread if an infected patient showed up, using protocols and equipment already in place. The question of whether a traveler could bring the illness to the New finding renews hope in fight against United States took on new urgency after a Liberian infected with Ebola superbugs flew to Nigeria and died there Friday. The Centers for Disease Control A soil sample from a national park in eastern Canada has produced a and Prevention, in an alert sent to healthcare facilities Monday, said that compound that appears to reverse antibiotic resistance in dangerous Ebola “poses little risk to the US general population at this time” but bacteria. Scientists at McMaster University in Ontario discovered that urged health workers to be alert for signs and symptoms in people who the compound almost instantly turned off a gene in several harmful recently traveled to Africa. bacteria that makes them highly resistant to treatment with a class of While it’s unlikely that a person with Ebola would arrive in the antibiotics used to fight so-called superbug infections. The compound, US, Boston physicians acknowledge it’s indeed within the realm called aspergillomarasmine A, or AMA, was extracted from a common of possibility. “I think we would be naive to think it’s not possible,” fungus found in soil and mold. said Dr. Nahid Bhadelia, associate hospital epidemiologist at Boston The Canadian team was able to disarm a gene—New Delhi Medical Center. Metallo-beta-Lactamase-1, or NDM-1—that has become “public All hospitals have protocols in place for dealing with dangerous enemy No. 1” since its discovery in 2009, says Gerard Wright, director and unusual infectious diseases. Typically, a patient with suspected of McMaster’s Michael G. DeGroote Institute for Infectious Disease Ebola would be put in an isolation room and staff would wear gowns, Research and lead researcher on the study. The report appears in gloves, goggles, and masks. Dr. Shira Doron, associate epidemiologist at the journal Nature. The McMaster team plans further experiments to Tufts Medical Center, said that normally a patient’s travel history might determine the safety and effective dosage of AMA. It could take as not come up until the person has already interacted with doctors and long as a decade to complete clinical trials on people with superbug other staff. “Given the increase in the number of cases of Ebola and the infections, Dr. Wright says. recent importation to Nigeria, we are taking it even more seriously right The researchers found that AMA, extracted from a strain of now,” she said. “We’re developing a plan to more aggressively screen Aspergillus versicolor and combined with a carbapenem antibi- patients who present to our hospital, our emergency room and our clin- otic, inactivated the NDM-1 gene in three drug-resistant super- ics, for travel history.” bugs—Enterobacteriaceae, a group of bacteria that includes E. coli; Massachusetts General Hospital is directing emergency room doc- Acinetobacter, which can cause pneumonia and blood infections; and tors to ask about travel history, a spokesman said; other hospitals said it Pseudomonas, which often infect patients in hospitals and nursing was already standard practice. homes. The NDM-1 gene encodes an enzyme that helps bacteria Ebola is a frightening illness because it dispatches its victims so become resistant to antibiotics and that requires zinc to survive. AMA quickly and violently. Within two to 21 days of exposure to the virus, an works by removing zinc from the enzyme, freeing the antibiotic to do infected person rapidly comes down with symptoms that include fever, its job, Dr. Wright says. Although AMA was only tested on carbapen- headache, weakness, vomiting, and diarrhea. Some will bleed inside and em-resistant bacteria, he expects the compound would have a similar outside the body. Blood pressure plummets, and within a few days the effect when combined with other antibiotics. organs fail. There is no treatment to attack the virus, but hospital care AMA was first identified in the 1960s in connection with leaf n can sometimes keep a person alive until the infection clears. wilt in plants and later investigated as a potential drug for treating high blood pressure. The compound turned up in Dr. Wright’s lab a Bacteria counts soar on elevator buttons few years ago during a random screening of organisms derived from A new study published in the journal Open Medicine suggests 10,000 soil samples stored at McMaster. The sample that produced that hospital elevator buttons contain more bacteria than surfaces in AMA was collected by one of Dr. Wright’s graduate students during hospital bathrooms. Swabs taken from 120 different elevator buttons a visit to a Nova Scotia park. It was the only sample of 500 tested that and 96 toilet surfaces in three different hospitals in Toronto found inhibited NDM-1 in cell cultures. more bugs on the buttons than in the bathrooms. The McMaster team developed a purified form of AMA for exper- The researchers say the types of bacteria they found on the but- iments on mice injected with a lethal form of drug-resistant pneu- tons were for the most part benign but that might not always be the monia. Treatment with either AMA or a carbapenem antibiotic alone case. They say it is important that hospital staff and visitors remember proved ineffective. But combining the substances resulted in more to clean their hands after pushing elevator buttons or use an elbow to than 95% of the mice still being alive after five days. The combination operate the unit. was also tested on 229 cell cultures from human patients infected “Elevators are touched repeatedly by ungloved hands by multi- with resistant superbugs. The treatment resensitized 88% of the sam- ple individuals who will later go on to contact patients,” explains Dr. ples to carbapenem. n Donald Redelmeier, director of clinical epidemiology at Sunnybrook Health Sciences Centre and senior author of the study. < 8