# 5880
In a follow up to Monday’s blog on the failure of the Indian government to restrict the over-the-counter sale of antibiotics, we’ve several news stories this morning that emphasize just how quickly NDM-1 and other forms of antibiotic resistance are spreading on the Indian subcontinent.
Many of these stories, no doubt, are inspired by this week’s global summit on antibiotic resistance being held in New Delhi.
NDM-1, or New Delhi metallo-ß-lactamase-1, is an enzyme that confers antibiotic resistance to several common types of bacteria. This emerging form of antimicrobial resistance made huge headlines in a Lancet study in August of last year:
Of particular concern, this enzyme is carried by a plasmid – a snippet of portable DNA - that can be transferred to other types of bacteria (see Study: Adaptation Of Plasmids To New Bacterial Species).
Since then, sporadic NDM-1 cases have been identified in countries around the world, with the vast majority of them having some link to a previous medical procedure or treatment in India or Pakistan.
The Indian government’s response was first to deny that a problem with NDM-1 existed and to take serious umbrage over the naming of the pathogen.
Under pressure to act, promises to restrict the sale of antibiotics were made in October of last year, but have yet to be implemented.
Again in April of this year, The Lancet published another study by Timothy Walsh, Janis Weeks , David M Livermore, and Mark A Toleman that looked for – and found – bacteria carrying the NDM-1 enzyme in New Delhi's drinking water supply.
Lancet Study: NDM-1 In New Delhi Water Supply
A snippet from the press release stated ominously (emphasis mine):
Resistant bacteria were found in 4 per cent of the water supplies and 30 per cent of the seepage sites. The researchers identified 11 new species of bacteria carrying the NDM-1 gene, including strains which cause cholera and dysentery.
In an interview for Reuters, co-author Mark Toleman of Britain’s Cardiff University School of Medicine stated that as many as 500,000 residents of New Delhi may be carrying the NDM-1 resistance gene in their gut flora.
The response from the Indian government, again, was one of denial (see Hopefully, It’s Just A Stage They Are Going Through).
Indian officials claimed that the researchers `illegally transferred’ samples of tap water out of the country, stated that the research was `unscientific’ and insist that the researchers were intentionally biased.
Which brings us to several stories this morning that go a long ways towards confirming many of the findings of these two much-maligned-in-India Lancet studies.
First stop, the The Economic Times.
Ganga Ram study finds high levels of superbug NDM1
5 Oct, 2011, 1114 hrs IST, Durgesh Nandan Jha, TNN
NEW DELHI: India might have vehemently opposed an antibiotic-resistant superbug being named New Delhi Metallo-beta-lactamase 1 (NDM1), but a study in a leading city hospital has found a worryingly high prevalence of the deadly gene.
The study, conducted over a 5-month period, examined 10,889 samples from patients. The NDM1 resistance gene was found in 8.1% of E. coli samples and 38.02% of samples of K. pneumoniae.
In the article, Dr S P Byotra, chairperson of medicine at the Ganga Ram Hospital, is quoted as saying:
"The idea behind this study is to stop denying the crisis NDM1 poses and work out strategies to check its spread. Antibiotic usage needs to be monitored strictly and good infection-control methods should be put in place at hospitals."
Next, a related article in the International Business Times, that quotes Former Indian Council of Medical Research chief and chairman N.K. Ganguly saying that the multi-drug resistant New Delhi metallo-beta-lactamase-1 or NDM-1 comes from hospital waste that goes into Delhi's sewage water.
Presence of Antibiotic-Resistant Bacteria in Delhi Confirmed
October 5, 2011 1:26 PM EST
Another story, this time from IBN-Live, states that 60,000 newborns die each year in India due to various types of antibiotic resistant sepsis (including NDM-1).
Health | Updated Oct 05, 2011 at 11:48am IST
NDM-1 superbug hits neonatal ICUs, kills infants
And lastly, filed under the category of no-good-deed-goes-unpunished, two of the authors of the original Lancet study – Dr Timothy R. Walsh and Dr Mark Toleman – report a decidedly cool reception at this week’s global summit in New Delhi.
Savita Verma New Delhi, October 5, 2011 |
UK 'superbug' scientist-duo alleges boycott by Indian counterparts
Despite hosting a global summit this week, India still appears to be treating NDM-1 and antibiotic resistance as a public relations problem instead of a public health threat.
To be fair, India isn’t the only country with NDM-1 cases or growing carbapenem resistance. But the Indian sub-continent does appear to be a focal point – a situation often blamed on their longstanding lax controls on the use of antibiotics.
Short of seeing an extremely high mortality influenza pandemic, I can think of no looming medical crisis more dire than the growing threat of antimicrobial resistance.
The World Health Organization (WHO) and the CDC - along with other public health organizations around the world – used this year’s World Health Day – 7 April 2011 to promote sane antibiotic usage and awareness of antimicrobial resistance.
Given the these reports (and many others), increased surveillance, openness, and international cooperation – not indignation, intimidation, and denial – are the responses needed if we are to have any hope of stemming the rise of antibiotic resistance around the globe.
And we need these things now, as time is not exactly on our side.
