Superbug threat is for real

But Indian government does not think it is significant

By Manupriya
Published: Sunday 15 May 2011

superbugDRUG-resistant NDM-1 gene has been debated ever since India was identified a source of the gene in patients in the UK. The debate intensified on April 7, 2011, when the journal Lancet Infectious Disease published a paper which stated that the gene (New Delhi Metallo-betalactamase- 1) was found in tap water, rivulets and water pools in Delhi. The gene makes the microbe that carries it resistant to antibiotics.

Researchers led by School of Medicine at Cardiff University in the UK examined 50 tap water and 171 seepage water samples from various locations in Delhi. They also checked 70 sewage effluent samples from Cardiff waste water treatment plants. Two tap water samples and 51 seepage samples tested positive for NDM-1, whereas all Cardiff samples tested negative for it.

“The study design cannot be doubted and the conclusions, at present, are acceptable,” says Chand Wattal, chairperson of the department of microbiology at Sir Ganga Ram Hospital in New Delhi. Wattal had examined urine samples of 804 pregnant women between 2004 and 2008. He did not find NDM-1 in any. This, he believes, is an indirect evidence that the gene is not prevalent in India. “Every study may not find it, but that does not mean it does not exist,” says Yatin Mehta, chairperson of the Medanta Institute of Critical Care and Anesthesiology in Gurgaon. “There is an immediate need to enforce stringent rules for use of antibiotics and monitoring our water quality,” he says.

On April 12, the Union Ministry of Health and Family Welfare released the National Policy for Containment of Antibiotic Resistance. But it also issued a statement, which says, “The fact that patients respond well to medical and post-surgical antibiotic treatment indicates that NDM-1 is not a significant problem in India” (see ‘We need not unduly worry about NDM-1’).

Commenting on the study Sandip Buddhiraja, director, Institute of Internal Medicine, Max Hospital, says, “It is surprising how samples in India were collected without approval from the authorities.” Researchers must take government’s permission before collecting water samples. Now, the Indian Council of Medical Research has been urged to conduct an independent study.

image‘We Need Not Unduly Worry About NDM-1’

Director general of the Indian Council of Medical Research V M KATOCH says public health implications of the gene in India are limited

Comment on the experiments, their validity and the findings.

In August 2010, a report was published in Lancet Infectious Disease which inferred that NDM-1 possibly originated in India. It may, therefore, not be safe for patients in the UK to opt for surgery in India. The paper published in April this year proves the gene is widely distributed in New Delhi. Samples for the study were reportedly collected by a reporter working for a British TV channel. Since the reporter did not have an Indian national as partner, it is difficult to comment on the authenticity of the study. Focusing on one gene when several such organisms are globally present is questionable and the motive is not difficult to speculate. If this is a scientific issue we should talk about all such naturally occurring multi-drug resistant organisms.

Considering that genes can move from one bacterium to another, what steps are required?

Such phenomena occur in nature. These may have been happening since the creation of life. We need not unduly worry about it as we have no control over the process. There is little public health implication at present. But we must keep tight surveillance on the quality of water to contain all water-borne diseases. Efforts are being made to further strengthen hospital infection control systems and establish efficient surveillance.

Do you think the study will have an impact on the flow of foreign patients in India?

We do not think so. There is no evidence to suggest that our hospitals are not safe. We believe that it will be globally understood that infection due to such organisms is a matter of chance. We do not wish to discuss data from other countries to score points but we expect all others to be objective.

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