Drug-resistant 'superbug' traced to India

India rejects UK scientists' 'superbug' claim

CHENNAI: Scientists have tracked down a drug-resistant superbug that infects patients and
causes multiple organ failure to Indian hospitals but doctors here see in it the germ of a move
to damage the country's booming medical tourism industry.

The 'superbug' resistant to almost all known antibiotics has been found in UK patients treated
in Indian hospitals. Named after the Indian capital, it is a gene carried by bacteria that causes
gastric problems, enters the blood stream and may cause multiple organ failure leading to
death.

"India also provides cosmetic surgery for Europeans and Americans, and it is likely the
bacteria will spread worldwide," scientists reported in The Lancet Infectious Diseases Journal
on Wednesday. While the study has the medical world turning its focus on infection control
policies in Indian hospitals, the Indian Council of Medical Research has alleged a bias in the
report and said it is an attempt to hurt medical tourism in the country that is taking away huge
custom from hospitals in the West. "Such infections can flow in from any part of the world.
It's unfair to say it originated from India," said ICMR director Dr VM Katoch.

Katoch has reasons to fume, as the superbug NDM-1 (New Delhi metallo-beta-lactamase) is
named after the national capital, where a Swedish patient was reportedly infected after
undergoing a surgery in 2008. Since then there have been several cases reported in the UK
and in 2009, the health protection agency in the UK issued an alert on the 'gram negative'
bacterial infection that is resistant to even the most powerful and reserved class antibiotics
called carbapenems.

In a joint study led by Chennai-based Karthikeyan Kumarasamy, pursuing his PhD at

University of Madras and UK-based Timothy Walsh from department of immunity, infection
and biochemistry, department of medicine, Cardiff University researchers sought to examine
whether NDM-1 producing bacteria was prevalent in South Asia and Britain.

"We saw them in most of the hospitals in Chennai and Haryana. We estimate that the
prevalence of this infection would be as high as 1.5%," Kumarasamy told TOI. "We found
the superbug in 44 patients in Chennai, and 26 in Haryana, besides 37 in the UK and 73 in
other places across India, Pakistan and Bangaladesh," he said.

What makes the superbug more dangerous is its ability to jump across different bacterial
species. So far, it has been found in two commonly seen bacteria, E coli and K pneumoniae.
"We have found that the superbug has the potential to get copied and transferred between
bacteria, allowing it to spread rapidly. If it spreads to an already hard-to-treat bacterial
infection, it can be turn more dangerous," Kumarasamy said.

Senior doctors working in infection control said India lacks policies on antibiotics, infection
control and registries for hospital-acquired infections. By the ICMR director's own
admission, India cannot scientifically fight back allegations of being the source of such
superbugs, as the country does not have a registry of such hospital-acquired infections.

"Two in every five patients admitted to hospitals acquire infections. This extends the patient's
stay in the hospital, increases the expenses and causes side-effects," said Dr Dilip Mathai,
head of the department of internal medicine, Christian Medical College, Vellore.

For a long time, India has been seeing Extended Spectrum Beta-Lactamase (ESBL), which
are enzymes that have developed a resistance to antibiotics like penicillin. ESBL enzymes are
most commonly produced by two bacteria - E coli and K pneumoniae, the two bacteria in
which the new superbug has been found. "These were treated by a reserved class of
antibiotics called carbapenems. We have seen at least 3% of people infected with this do not
react to these reserved drugs," he said.

Public health experts say globalisation has allowed bacteria to spread rapidly across the world
and India, as a medical hub, should be geared for the challenge. Katoch, who is also the
secretary, department of medical research, agrees. "At present, we don't have any system in
place. There are neither rules for hospitals nor a registry to record hospital-acquired
infections. We are now in the process of forming a cell that will activate a registry and issue
guidelines for an integrated surveillance system," he said.

Read more: Drug-resistant 'superbug' traced to India - India - The Times of India
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India/articleshow/6295662.cms#ixzz0xLO1KW89

The World Health Organization

(WHO) on Friday announced that the health governing bodies and governments across the
globe should closely monitor the multi-drug resistant super bug that had surfaced in South
Asia and has now spread to Britain.

It has endorsed a recent report in The Lancet Infectious Diseases study

which stated that the super bug had evolved in India.

The report has identified a new gene due to which some bacteria are
resistant to almost every antibiotic .

"An article published in The Lancet on 11 August 2010 identified a new

gene that enables some types of bacteria to be highly resistant to almost all
antibiotics. The article has drawn attention to the issue of AMR, and, in
particular, has raised awareness of infections caused by multi-drug
resistant bacteria," the statement says.

The WHO has urged countries to take immediate action against the spread
of the bacteria, which can survive various antibiotics that are the only
cure for infectious diseases worldwide.

Focus on four major areas

The WHO recommends bodies to currently focus on four main areas:

1. It urges governments to have strict surveillance in place for

antimicrobial resistance.

2. Antibiotic use should be rational. Health workers and the public ought to
be educated about the appropriate use of antibiotics.

3. Legislation related to stopping the selling of antibiotics without

prescription should be introduced and enforced legally.

4. Lastly, there should be strict adherence to infection prevention and

control measures, including the use of hand-washing measures, particularly
in healthcare facilities.

"While multi-drug resistant bacteria are not new and will continue to
appear, this development requires monitoring and further study to
understand the extent and modes of transmission, and to define the most
effective measures for control," it added in a statement.

Super bug timebomb?

It's Britain's deadliest super bug, killing twice as many people as MRSA. Yet many of us
don't know about it until it's too late. Scientists in the East Midlands are at the forefront of
research into C-difficile and are working on a cure.

What is Superbug ? : UK scientists warn of worldwide spread of Super

bug Antibiotic resistant organism
Posted on Aug 11, 2010
UK scientists warn of worldwide spread of Superbug first let us know What is Superbug ?.
Super bug is a bacteria of Antibiotic resistant organism as its is identified in 37 people who
returned to the UK after undergoing surgery in India or Pakistan. This Superbug is as much
powerful that it is resistant to most Powerful antibiotics so UK/ British scientists passed a
warning that it will appear worldwide. Researchers already passing warning about this Super
Bug as it will spreads more where the health system is low which is not having adequate
medicines/ antibiotics. superbug is now calling as New Delhi metallo inappropriate

In an article published online in the journal Lancet Infectious Diseases today on August 11,
2010, doctors reported finding a new gene, called NDM-1. The gene alters bacteria, allowing
them to become resistant to nearly all known antibiotics. It has been seen largely in E. coli
bacteria, the most common cause of urinary tract infections, and on DNA structures that can
be easily copied and passed onto other types of bacteria.

India today described as “totally irrational” a report that a new superbug  resistant to
antibiotics originated from the country and strongly protested a British alert in this regard and
the new enzyme being named as ‘New Delhi Metallo- 1′.

The medical fraternity in the capital is miffed at the report on a superbug published in the
Lancet Infectious Disease journal. Experts say the nomenclature of the superbug — New
Delhi  metallo-beta-lactamase 1 (NDM-1) — is inappropriate as the bug was isolated from
Chennai and Haryana. Though India plans to contest the finding of the study and present its
side strongly at international forums, doctors say it’s high time we take a serious look at
hospital infections here and the irrational use of antibiotics.

“The nomenclature and the conclusions of the study are not appropriate. The bug was not
isolated in Delhi, then how can they name it after the capital?” Dr Sharman Singh of AIIMS
asks. Doctors say that the findings of the study will have a damaging effect on Indian medical
tourism.

Dr David Livermore, one of the researchers and who works for the UK’s Health Protection
Agency (HPA), said: “The NDM-1 problem is likely to get progressively worse in the
foreseeable future. “The potential for wider international spread and for NDM-1 to become
endemic worldwide are clear and frightening.” Infections have already been passed from
patient to patient in UK hospitals. Researchers say the way to stop NDM-1 is to identify and
isolate any patients who are infected.

“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.

The potential of NDM-1 to be a worldwide public health problem is great, and coordinated
international surveillance is needed,” the authors wrote. Aside from the U.K., the resistant
gene has also been detected in Australia, Canada, the Netherlands, the U.S. and Sweden. The
researchers said that since many Americans and Europeans travel to India and Pakistan for
elective procedures like cosmetic surgery, it was likely the superbug would spread
worldwide.

The spread of these multi-resistant bacteria merits very close monitoring,” wrote Johann
Pitout of the division of microbiology at the University of Calgary, Canada, in an
accompanying commentary. Pitout called for international surveillance of the bacteria,
particularly in countries that actively promote medical tourism. The consequences will be
serious if family doctors have to treat infections caused by these multi-resistant bacteria on a
daily basis.”

conclusion about superbug

India rejects superbug linkage

Aarti Dhar

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India has reacted strongly to a study linking a multiple drug-resistant superbug detected in
Britain to India and said the bacteria are not a public health threat.

It said Indian hospitals were safe as a number of such bacteria survived in nature and were
reported from several other countries.

The conclusions of the study are “loaded with inference'' that the antibiotic-resistant organism
possibly originated in India, an official statement by the Ministry of Health and Family
Welfare said here on Thursday.

“While such organisms may be circulating more commonly in the world due to international
travel, to link it with the safety of surgery hospitals in India and citing isolated examples to
show that India is not a safe place to visit due to the presence of such organism in Indian
environment are wrong,” V.M. Katoch, Director-General, Indian Council of Medical
Research, said here.

Several authors had declared a conflict of interest in the publication of the study. The study
was funded by the European Union and two pharmaceutical companies — Wellcome Trust
and Wyeth — that produce antibiotics for treatment of such cases, the statement said.

The government also strongly objected to the naming of this enzyme as New Delhi metallo
beta lactamase -1 (NDM-1) and refuted the conclusion that hospitals in India were not safe
for treatment.

Admitting that such news reports were likely to dent the prospects of medical tourism in the
country, Dr. Katoch said correct reporting by the media should inform the people and set the
matter right. “Indian hospitals are world class and follow the best practices,” Dr. Katoch said.

Though not disputing the validity of the study, he said the conclusions were “unfair” and
“scary.” The conclusions and interpretations of the study were wrong, scientifically invalid
and aimed at creating a scare.
Superbug on the prowl in India

London: British scientists have found a superbug that is resistant to most antibiotics and are
warning that it is widespread in India and could soon appear worldwide. The superbug has so
far been identified in 37 people who returned to the UK after undergoing surgery in India or
Pakistan.

In an article published online Wednesday in the journal Lancet Infectious Diseases, doctors
reported finding a new gene, called NDM-1. The gene alters bacteria, allowing them to
become resistant to nearly all known antibiotics.

It has been seen largely in E. coli bacteria, the most common cause of urinary tract infections,
and on DNA structures that can be easily copied and passed onto other types of bacteria. The
researchers said the superbug appeared to be already circulating widely in India, where the
health system is much less likely to identify its presence or have adequate antibiotics to treat
patients.

"The potential of NDM-1 to be a worldwide public health problem is great, and coordinated
international surveillance is needed," the authors wrote. Aside from the U.K., the resistant
gene has also been detected in Australia, Canada, the Netherlands, the US and Sweden.

The researchers said that since many Americans and Europeans travel to India and Pakistan
for elective procedures like cosmetic surgery, it was likely the superbug would spread
worldwide.

"The spread of these multi-resistant bacteria merits very close monitoring," wrote Johann
Pitout of the division of microbiology at the University of Calgary, Canada, in an
accompanying commentary.

Pitout called for international surveillance of the bacteria, particularly in countries that
actively promote medical tourism. "The consequences will be serious if family doctors have
to treat infections caused by these multi-resistant bacteria on a daily basis."

22 superbug cases in just one hospital...

MUMBAI: Twenty-two patients in three months in a single hospital. This statistic should
serve as an answer to anyone who wants to understand why the NDM-1 (New Delhi metallo-
beta-lactamase-1) is creating ripples — both within India and in the rest of the world.

Hinduja Hospital in Mahim isolated the super bacteria in 22 patients within a span of three
months. This has happened within a year of the bacteria being isolated for the first time by
European doctors in a Swedish patient who had travelled to New Delhi for an operation.

"If a single hospital can isolate such a significant number of bacteria with a new resistance
gene in a short period of time; the data from all the Indian hospitals, if available would
potentially be more interesting and shocking than the human genome project data, which is
considered as a discovery more important than the moon landing itself," wrote Dr Abdul
Ghafar K, consultant in infectious diseases at Apollo Hospital, Chennai, in an editorial in
JAPI, one of the leading Indian research journals.

A senior microbiologist from Mumbai who doesn't want to be named believes that mutations
in bugs — to create superbugs — can only occur in countries like India where antibiotics are
routinely overused or abused.
But Dr Abhay Chaudhary, president of the Indian Association of Medical Microbiologists
believes that the European conclusion that it originated from the Indian subcontinent is not
substantiated. "Some of the extrapolations in the study which appeared in the study that
appeared in the Lancet Infectious Diseases journal are inappropriate," he said.

While the truth about NDM-1's origins remain debatable, there are few things most Indian
doctors agree upon: widespread abuse and overuse of antibiotics and the subsequent
resistance in the community. In his JAPI article in March, Dr Ghafur wrote, "Our country,
India, is the world leader in antibiotic resistance; in no other country antibiotics been misused
to such an extent."

Read more: 22 superbug cases in just one hospital... - India - The Times of India
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Experts have warned that a new type of drug-resistant superbug is emerging in UK hospitals.

Q: What is NDM-1?

New Delhi metallo-ß-lactamase-1, or NDM-1 for short, is a gene carried by bacteria that
makes the strain resistant to carbapenem antibiotics. This is concerning because these
antibiotics are some of the most powerful ones, used on hard-to-treat infections that evade
other drugs.

Q: Why is this a problem?

NDM-1 (or more precisely the DNA code for this enzyme) can easily now jump from one
strain of bacteria to another.

Experts are worried that it may end up in another bacterium which is already resistant to
many other antibiotics.

Ultimately, it could produce dangerous infections that would spread rapidly from person to
person and be almost impossible to treat.

Q: Can it be treated?

Other treatment options are available to fight these infections but they present major
challenges for clinicians and will often demand combinations of antibiotics are used.
Scientists have identified some strains that have been resistant to all known antibiotics.

Q: How would I know if I had it?

So far, many of the UK cases have been in patients who have recently travelled to India or
Pakistan for medical treatment and who caught the infection while there.

But, some of these patients have passed the infection on to others in UK hospitals upon their
return.

The infections have ranged from mild to severe - and some have been fatal.

Two types of bacteria have been host to NDM-1: the gut bacterium E.coli and another that
can invade the lungs called Klebsiella pneumonia. Both can lead to urinary tract infections
and blood poisoning.

Infections such as these would usually be spotted in patients by medics.

Q: Can its spread be stopped?

Experts say the way to stop it is through surveillance, rapid identification and isolation of any
hospital patients who are infected.

Normal infection control measures, such as disinfecting hospital equipment and doctors and
nurses washing their hands with antibacterial soap, can stop the spread.

NDM-1 is already widespread in the Indian subcontinent and has also reached countries
including the US, Canada, Australia and the Netherlands. Scientists believe it has the
potential to become a global public health issue.

And they say we now need new drugs to treat resistant strains.

Q: Are there new antibiotics that could help?

While there is a great deal of investment in research to find new antibiotics, experts say that
most of the drugs currently in the pipeline will be useless for treating NDM-1 positive
patients.

This is because the bacteria that carry NDM-1 are Gram-negative, while most of the work is
being carried out for Gram-positive bugs like MRSA.

The Health Protection Agency says "multi-resistant Gram-negative bacteria pose a notable
public health risk and it remains important that the pharmaceutical industry continues to work
towards developing new treatment options".

The Department of Health said it was investigating ways of encouraging the development of
new antibiotics with European colleagues.

Q: What will happen now?

The government said HPA would continue to monitor the situation and would regularly
review the data and the need for further action.

In the meantime, hospitals should ensure they continue to provide good infection control to
prevent any spread, and consider whether patients have recently been treated abroad and send
samples to HPA for testing if necessary.