India's medical tourism hit by a 'Superbug'

London: A new superbug from India could spread around the world – in part because of medical tourism – and scientists say there are almost no drugs to treat it.

Researchers said on Wednesday they had found a new gene called New Delhi metallo-beta-lactamase, or NDM-1, in patients in South Asia and in Britain.

US health officials said on Wednesday there had been three cases so far in the United States – all from patients who received recent medical care in India, a country where people often travel in search of affordable healthcare.

NDM-1 makes bacteria highly resistant to almost all antibiotics, including the most powerful class called carbapenems. Experts say there are no new drugs on the horizon to tackle it.

"It's a specific mechanism. A gene that confers a type of resistance (to antibiotics)," Dr. Alexander Kallen of the US Centers for Disease Control and Prevention in Atlanta said in a telephone interview.

With more people traveling to find less costly medical treatments, particularly for procedures such as cosmetic surgery, Timothy Walsh, who led the study, said he feared the new superbug could soon spread across the globe.

"At a global level, this is a real concern," Walsh, from Britain's Cardiff University, said in telephone interview.

Almost as soon as the first antibiotic penicillin was introduced in the 1940s, bacteria began to develop resistance to its effects, prompting researchers to develop many new generations of antibiotics. But their overuse and misuse have helped fuel the rise of drug-resistant "superbug" infections like methicillin-resistant Staphyloccus aureus, or MRSA."Because of medical tourism and international travel in general, resistance to these types of bacteria has the potential to spread around the world very, very quickly. And there is nothing in the (drug development) pipeline to tackle it."

Medical Tourism.

In a study published in The Lancet Infectious Diseases journal on Wednesday, Walsh's team found NDM-1 was becoming more common in Bangladesh, India, and Pakistan and was also imported back to Britain in patients returning after treatment.

"India also provides cosmetic surgery for other Europeans and Americans, and it is likely NDM-1 will spread worldwide," the scientists wrote in the study.

Walsh and his international team collected bacteria samples from hospital patients in two places in India, Chennai and Haryana, and from patients referred to Britain's national reference laboratory from 2007 to 2009.

They found 44 NDM-1-positive bacteria in Chennai, 26 in Haryana, 37 in Britain, and 73 in other sites in Bangladesh, India and Pakistan. Several of the British NDM-1 positive patients had traveled recently to India or Pakistan for hospital treatment, including cosmetic surgery, they said.

NDM-1-producing bacteria are resistant to many antibiotics including carbapenems, the scientists said, a class of the drugs reserved for emergency use and to treat infections caused by other multi-resistant bugs like MRSA and C-Difficile.

Kallen of the CDC said the United States considered the infection a "very high priority," but said carbapenem resistance was not new in the United States. "The thing that is new is this particular mechanism," he said.

Experts cited two drugs that can stand up to carbapenem-resistant infections – colistin, an older antibiotic that has some toxic side effects, and Pfizer's Tygacil.

For many years, antibiotic research has been a "Cinderella" sector of the pharmaceuticals industry, reflecting a mismatch between the scientific difficulty of finding treatments and the modest sales such products are likely to generate, since new drugs are typically saved only for the sickest patients.

But the increasing threat from superbugs is encouraging a rethink at the few large drugmakers still hunting for new antibiotics, including Pfizer, Merck, AstraZeneca, GlaxoSmithKline and Novartis.

Anders Ekblom, global head of medicines development at AstraZeneca, whose Merrem antibiotic was the leading carbapenem, said he saw "great value" in investing in new antibiotics.

"We've long recognized the growing need for new antibiotics, he said. "Bacteria are continually developing resistance to our arsenal of antibiotics and NDM-1 is just the latest example."

source- ibnlive

Drug-resistant 'superbug' traced to India

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.




source- times of india

Linking superbug to India irrational

 India described as "totally irrational" British scientists linking a new superbug resistant to antibiotics to this country and said it was responding to an alert issued by Britain in this regard. 

V M Katoch, Secretary of Health Research, told media that the government would soon draft a reply to this after a meeting of the National Centre for Disease Control (NCDC), a nodal agency under the Health Ministry. 

"When you link it to something to our anti-biotics policy, say India specific, say it is dangerous to get operated in India then you will get more infections, that is totally irrational," he said. 

Katoch said the Health ministry will examine the issue in detail but it was "unfortunate that this new bug, which is an environmental thing, has been attached to a particular country which is India in this case". 

"I am surprised," he said, adding that, "this (the bug) is present in nature. It is a random event and cannot be transmitted". 

Katoch said that he was surprised that a research paper linked it with India as they should know it was a biological phenomenon. 

The issue also figured in the Rajya Sabha where members suspected the hands of multinational pharmaceutical and hospital companies behind the claims. 

"When India is emerging as a medical tourism destination, this type of news is unfortunate and may be a sinister design of multinational companies" to defame the Indian medical sector, S S Ahluwalia (BJP) said. 

Demanding a response from the government, he said some foreign tourists after returning from India reported some infection and attributed it to Indian hospitals. "It may not be true," he said. 

Ahluwalia, who was supported by Jayanti Natarajan (Congress), said there should be a system of maintaining a registry for patients suffering from infectious diseases. 

Natarajan said reports of superbug, attributable to India, is a "wrong propaganda against the country". 

According to a paper published in scientific journal 'Lancet', the new superbug, which is said to be resistant even to most powerful antibiotics, has entered UK hospitals and is travelling with patients who had gone to countries like India and Pakistan for surgical treatments. 

Bacteria that make an enzyme called NDM-1 or New Delhi-Metallo-1, have travelled back with NHS patients who went abroad to countries like India and Pakistan for treatments such as cosmetic surgery, it said. 

Although there have only been about 50 cases identified in the UK so far, scientists fear it will go global. NDM-1 can exist inside different bacteria, like Ecoli, and it makes them resistant to one of the most powerful groups of antibiotics-carbapenems.

source- times of india

Indian' superbug

The superbug, which is resistant to almost all antibiotics, has hit Canada after Australia and UK.

At least two Canadians have become infected with the dangerous new superbug from India that is spreading around the world, partly due to medical tourism. The superbug has Canadian public-health experts bracing for outbreaks.

"There will be others. It's just a matter of time," the Globe and Mail quoted Dylan Pillai, a medical microbiologist at the Ontario Agency for Health Protection and Promotion as saying. "It's just the nature of the beast."

Researchers reported dozens of cases of British, Indian and Pakistani patients who contracted infections caused by bacteria harbouring an enzyme called New Delhi metallo-beta-lactamase, or NDM-1, in the journal The Lancet Infectious Diseases.

Of 29 Britons, more than half had recently travelled to India or Pakistan and 14 had been admitted to hospitals in the subcontinent, where the drug-resistant enzyme originated, including for kidney transplants and cosmetic surgery.

Two cases have been confirmed among Canadians who spent time in India. In addition, the drug-resistant infection has been found in patients from the United States, Sweden, the Netherlands and Australia. (ANI)