The spreading superbug

Still waiting for a crackdown on antibiotic over-prescription

According to a recent study in the Lancet Infectious Diseases journal, the drug-resistant bacterial strain known as New Delhi metallo-beta-lactamase 1, or NDM-1, has spread to 40 countries. This is quite remarkable, given that it was only discovered in 2008 in the UK, among patients who had recently been hospitalised in India. The “superbug”, as it is commonly known, is feared for its ability to cause many types of bacteria to become resistant to most antibiotics. This could turn previously incurable diseases fatal. It is, of course, important to both control its spread and look urgently for alternative antibiotics that are more effective against it. If not, the consequences could be catastrophic — a health hazard more formidable than any encountered in the recent past.

The strain is essentially a protein (gene) that imparts immunity to bacteria against the existing beta-lactam antibiotics. Even carbapenems, the strongest class of antibiotics – used by doctors as a last resort – could lose their healing power. Even at the time of its discovery, this drug-resistant gene was already present in several countries — Pakistan, the UK, the US, Canada, Japan and Brazil. It has since migrated to more regions because of its capacity to jump from one bacterium to another easily, mutating into more virulent forms. As such, it can infiltrate into common bacteria, such as Escherichia coli, or E coli (found in the human digestive tract), Klebsiella (which infects lungs and the respiratory system, causing pneumonia and other maladies) and many others inhabiting soil and water. Most vulnerable are the patients with weakened immune systems after surgery or due to diseases like septicaemia, pneumonia, gastroenteritis and such others.

India’s response to NDM-1, which clearly evolved in its hospitals, has been appalling. Public anger focused not on the dysfunctional health system and its practice of over-prescription that caused the problem, but on the scientists who had the temerity to name it for its place of apparent origin. Worse, the union health ministry was dismissive, instead asking how it had been discovered, and whether the paperwork for the samples used to study it was in order. While the health establishment worried about nomenclature, the factors that can cause the dissipation of such strains into the environment continue to be horrific in India. These include problematic hygiene; the improper disposal of medical waste; poor disinfection of hospitals, notably their intensive care units (ICUs); and, of course, the indiscriminate use of antibiotics for human and veterinary health. Surveys conducted in response to the superbug scare in 2010 discovered that NDM-1 was present in the ICUs of many leading hospitals in Indian cities. Though the hospitals were directed to decontaminate their premises and take precautionary biosafety measures, their caution, predictably, was short-lived. A task force set up by the government in 2010 made several recommendations, ranging from strengthening infection control mechanisms in hospitals to restricting the use of antibiotics by allowing their sale strictly on prescription from qualified medical practitioners. Sadly, this sane counsel has remained on paper only. Public health in India, and the world, requires a crackdown on the over-prescription of antibiotics; it is a matter literally of life and death.