Superbug: India gets bugged

Government downplays threat from drug-resistant bacteria

By Jyotika Sood
Published: Wednesday 15 September 2010

imageA DRUG-RESISTANT bacteria dubbed superbug has triggered a debate. A gene—New Delhi metallo-beta lactamase (NDM 1)— transforms some bacteria found in the gut, like Escherichia coli and Klebsiella pneumoniae, into superbugs.

They are resistant to all antibiotics, except tigecycline and colistin, said a study published in the August 11 issue of The Lancet Infectious Diseases.

The study, based on a survey conducted in India, Pakistan and the UK, ended with an advisory to patients in the UK that they should not to opt for surgeries in India. In June, the superbug killed a Belgian patient who underwent treatment in Pakistan. The World Health Organization has endorsed the report. It has asked governments to focus on prevention and control through surveillance for anti-microbial resistance, rational use of antibiotics and preventing sale of antibiotics without prescriptions.

Study motivated: doctors

The study rocked the Indian Parliament on August 12. MPs called it a conspiracy by multinational pharmaceutical firms to discredit India as a healthcare destination. Last year, a study by the Confederation of Indian I n d u s t r y and Mckinsey India had predicted that India could earn US $2.4 billion from 2009 to 2012 through medical tourism. The MPs also accused Karthikeyan N Kumaraswamy of Madras University's microbiology department of conflict of interest. A coauthor of the study, Kumaraswamy travelled to UK courtesy pharma company Wyeth.

"The motive behind the study, sponsored by the European Union, Wyeth and Wellcome Trust, a charity, needs to be investigated. It is an attempt to sabotage India's healthcare industry that provides affordable treatment," said Raman Sardana of Hospital Infection Society of India, an association of doctors. Another doctor with the association said there is no concrete evidence of NDM-1 developing in India. The researchers don't know the extent of the spread and since when the bacteria became prevalent in the environment, he said.

Nakun Jain of Health India, a company providing healthcare trips to India, said the superbug has disturbed patients in the UK, though South American and South African visitors remain unaffected. Hospitals in India that would be hit include the Apollo group and Escorts.

What India needs to do

The superbug is not new. NDM-1 was first discussed at an international conference on antibiotic agents and chemotherapy in Washington in October 2008.

Research groups in Mumbai published independent studies on it in the Journal of Association of Physicians of India in March 2010. The greater concern now is that this resistant gene may have passed on to other strains of bacteria which may result in complete resistance to any type of broad spectrum antibiotic, said a researcher associated with study published in The Lancet Infectious Diseases.

V M Katoch, director general of the Indian Council for Medical Research, said bacteria with resistant gene like NDM-1 are commonly found in the environment. So, stringent infection control measures should be taken, he said. But so far neither the Indian Council for Medical Research nor the health ministry has conducted any surveys on infection control in hospitals.

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