Superbug on the prowl in India, UK scientists warn of worldwide spread

[SHASH2K2]

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 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.''

Read more: Superbug on the prowl in India, UK scientists warn of worldwide spread - Science - Home - The Times of India http://timesofindia.indiatimes.com/...-spread/articleshow/6293126.cms#ixzz0wJJ8TGAH


http://timesofindia.indiatimes.com/home/science/Superbug-on-the-prowl-in-India-UK-scientists-warn-of-worldwide-spread/articleshow/6293126.cms

 

[Iamanidiot]

is it to discourage medical tourism in india or something.Or is it real

 

[Agantrope]

Propoganda machine of the west is at its best.

Medical expenses here are damn cheap, They cant digest the fact that they are losing the money here to a developing nation. West is getting their own taste of Corporate Raj and Globalisation.

 

[SHASH2K2]

All links on the web point to only on report or article in UK. It looks like a propaganda to discourage medial tourism to cheap destinations like India .

 

[hit&run]

MRSA precaution protocols are not in place in any of Indian hospital. We do have technology to detect and treat these infections but do not have resources to stop its spread from our wards, equipments, staff and patients.

The first line of defence is to keep any patient admitted in to any hospital with any complication in isolation with previous history of hospital treatment straight away. Do his swab test or any other test to rule out if he is not infected with MRSA or VRE. These test are very very costly and can be done within 24 to 72 hrs of time depending on the available technique. Therefore Isolating a patient and doing his treatment by implicating precautions and protocols for the same for 2 days is big mammoth task for already over saturated, out staff and out resourced hospitals.

It is further more troublesome for both hospital and patient himself if fortunately tested and unfortunately found positive. The precautions are supposed to continue for rest of his life until unless not found negative or sterile from the strain on repeated test after ~6 months or if required clinically. The mortality rate is higher if the illness due to such infection or any other secondary infection is widespread or disseminated etc. As is said we know the treatment (regime of medicine) but its difficult, costlier and needs prolong hospitalization.

Compliance: If a patient is operated/treated upon and has recovered well from his chief complaint (compliance in hospital is very good). Is Discharged back home with positive strains without any clinical symptom of illness but a positive finding that he or she has resistance against all mainstream antibiotics; the socio economic factors, standard of living and financial constrains do start to play their role. Although patient positive with such strains can live a normal life forever without any complications but the risk of spreading these resistant strains to others is always there if a compliance to domiciliary treatment if advised is poor and precautions are not obeyed religiously.

Lack of awareness.

Unethical practise by practitioners and greed of hospitals: The reason behind this greed is sometimes patient himself who will not go to a hospital where the cost of the treatment is very high and a already struggling practitioner due to sever competition will give him a package where in most of such tests are not done to save his money. I am sure whosoever NRI is coming to India for any treatment is going for a cheap treatment to save money so that he can spend rest on ticket and fun.

Disclaimer: Please search pure medical articles to learn details about this so called super bug for its classification, etiology, pathophysiology, prognosis and treatment etc. what i have mentioned is my own view which i have observed during 3 years of practice in different Indian hospitals and 3 years of learning the way Australian and NZ hospitals are treating their patients. At any given time i would like to be treated myself in Australia or NZ even if it will cost me the fortune.

 

[Daredevil]

I just read the original lancet infectious disease article in which they mention about this NDM-1 superbug. I'm baffled that being a scientific paper they made a general comment - "Several of the UK source patients had undergone elective, including cosmetic, surgery while visiting India or Pakistan". Instead of showing statistics of how many patients who visited India has contracted this superbug, they have made this vague and general comment. If they were honest and didn't want to malign Indian hospitals they would have given out the figures, but they didn't do that indicating that they wanted to scare people away from India to go for treatment and discourage medical tourism. Their ulterior motives can be seen in this statement of article "India also provides cosmetic surgery for other Europeans and Americans, and blaNDM-1 will likely spread worldwide. It is disturbing, in context, to read calls in the popular press for UK patients to opt for corrective surgery in India with the aim of saving the NHS money.29 As our data show, such a proposal might ultimately cost the NHS substantially more than the short-term saving and we would strongly advise against such proposals." Its very disgusting of these scientists and their backers.

 

[civfanatic]

When I first saw the title of the thread, I thought it was going to be about F-18s.

 

[Daredevil]

specefic to India only..created by imagination to prolly sell a few drugs later on

This superbug is specific to Indian hospitals or can occur anywhere?

They have collected samples from UK, India and Pakistan and found this super bug in all the countries with different percentages. For example in India they were found in 4-26% of the samples they have collected from while in UK it was 44%. So, the prevalence is much more in UK than in India. But they have manipulated the statement in such a way that the blame goes to India and Pakistan.

It will be known if this super-bug is found in other countries or not once they start testing for the NDM-1 gene that is specific for this super-bug making it resistant almost 95% of antibiotics.

 

[SHASH2K2]

First aim of such article to is reduce medical tourism coming to countries like India and and secondly to market some wonder drugs as cure to these Super bugs at later stages. Looks like they are upto something. May be we will hear news about some wonder drugs very soon.

 

[hit&run]

1.In a pre admission workup Patient's pre hospitalization history is asked.

2.It is again asked by on duty nurse at admission. It is a medical negligence if a nurse is not asking/recording a patient if he was pre hospitalized.
If the answer is yes then she will jump away to snatch disposable apron/gown, gloves and mask. She will put a big label on the bed or at the door 'MRSA Precautions in place. MRSA precautions are: Isolation, disposable gown glove and mask. you can not carry even your pen or equipment inside (Dedicated instruments). Doctor, pathologist will see him at last if not clinically required during rounds. Once entered in his room can not go out without completing course of treatment if so then have to wash gown glove again. Laundry, disposal etc separate.(not mentioning treatment).
3. If found positive a record is made in Pathology data base.
4.Previous hospital is informed.
5. When my hospital was informed about a Patient previously discharged from us. Our labs, wards OT floor, wall, roofs, ventilators and random equipment rub swabs were sent for the tests if the stains are positive or not. So they do thorough investigations and medical investigations do not cover up facts for nationalistic bias specially when practitioner of other nations are the culprit .
5. If a patient is referred to another hospital they literally do start crying if we tell the patient is MRSA positive (Burden of treatment and sincerity).
6. Super bug positive Patients frequently sue hospitals in Australia.
.....................
As far as India is concerned, if we want to save our medical tourism the we should do ethical treatment which is costlier but still not costlier for a NRI. Indian here are talking about a notorious micro organism with macroscopic approach, this is not good. If we are sincere about our business then we must implicate strict rule and regulation for all. Even if a hospital treating NRI will follow such rules and ethics for NRIs he may not do the same with poor Indian fellow. That is why being a aware person if i be able alarm my Indian practitioner for such precaution. He may do that for me but i will never be satisfied if he is not doing for rest and if his staff is not skilled enough in a culture of following such practises. If you want to run a bussiness, run it they way it should be to sustain it for a long time. But when you are treating a patient medically and earning a bussiness at the same time your duties demand no shoddy shortcuts.
..................................

Its very easy to shut all allegations, simply do tests pre and post treatment tests and send the NRI back from where he has come with negative reports. (dud ka dud pani ka pani)

Its a burden on developed nation to treat MRSA positive patients, since the treatment is paid by the govt. therefore hospitals are answerable to public and govt. India must invest and implicate international standards. o... actually there are no international standards but law and rules medical science are universal. Indian doctors do study those laws in their collages (better than international students). But when they go out in the field realities are different its like law of jungle even for a doctor who is supposed to be prevail but struggle to survive.

Ok....enough with melodramatic excuses for a doctor. Indian doctor must do ethical practise at any cost, may die of hunger but not do shoddy jobs.

One more thing i would like mention here which is very important. The other big reasons for resistance against antibiotics is readily available antibiotics from the Pharmacist counter without prescription. We stopped using gentamicin in 80-90 cause it was resistant in 50-70 % of population. Same is the story with many first choice of anti microbial drugs. I was surprised to see sever infections treated with many first generations antibiotics in Australia. I still remember a snub from my boss when i prescribed a first gen antibiotic for a nosocomial chest infection, he told me 'you have signed his death warrant'. Though it was stronger that what Oz hospital still use.

 

[hit&run]

SHASH2K2 1 Hour Ago
This superbug is specific to Indian hospitals or can occur anywhere?

South Korea, Indonesia, Singapore are pioneering in medical tourism. Their drug control laws are stricter than ours. It tells the whole story if we have to compare. There are many pro and cons in getting a medical job done from a distant place. When such patients do face those cons when they are back to their developed nations the system reacts badly cause they treat them for free of cost if the complication is systemic but due to surgery done some where else like this superbug. Its a fair criticism and an alarm for countries like India who wants to earn revenue. We must address this problem rather exfoliating conspiracy theories.

 

[SHASH2K2]

Antibiotic-Resistant Bacteria Moving From South Asia to U.S.

A dangerous new mutation that makes some bacteria resistant to almost all antibiotics has become increasingly common in India and Pakistan and is being found in patients in Britain and the United States who got medical care in those countries, according to new studies.

Experts in antibiotic resistance called the gene mutation, named NDM-1, "worrying" and "ominous," and they said they feared it would spread globally.

But they also put it in perspective: there are numerous strains of antibiotic-resistant germs, and although they have killed many patients in hospitals and nursing homes, none have yet lived up to the "superbug" and "flesh-eating bacteria" hyperbole that greets the discovery of each new one.

"They're all bad," said Dr. Martin J. Blaser, chairman of medicine at New York University Langone Medical Center. "Is NDM-1 more worrisome than MRSA? It's too early to judge."

(MRSA, or methicillin-resistant staphylococcus aureus, is a hard-to-treat bacterium that used to cause problems only in hospitals but is now found in gyms, prisons and nurseries, and is occasionally picked up by healthy people through cuts and scrapes.)

Bacteria with the NDM-1 gene are resistant even to the antibiotics called carbapenems, used as a last resort when common antibiotics have failed. The mutation has been found in E. coli and in Klebsiella pneumoniae, a frequent culprit in respiratory and urinary infections.

"I would not like to be working at a hospital where this was introduced," said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University. "It could take months before you got rid of it, and treating individual patients with it could be very difficult."

A study tracking the spread of the mutation from India and Pakistan to Britain was published online on Tuesday in the journal Lancet.

In June, the Centers for Disease Control and Prevention noted the first three cases of NDM-1 resistance in this country and advised doctors to watch for it in patients who had received medical care in South Asia. The initials stand for New Delhi metallo-beta-lactamase.

"Medical tourism" to India for many surgeries — cosmetic, dental and even organ transplants — is becoming more common as experienced surgeons and first-class hospitals offer care at a fraction of Western prices. Tourists and people visiting family are also sometimes hospitalized. The Lancet researchers found dozens of samples of bacteria with the NDM-1 resistance gene in two Indian cities they surveyed, which they said "suggests a serious problem."

Also worrying was that the gene was found on plasmids — bits of mobile DNA that can jump easily from one bacteria strain to another. And it is found in gram-negative bacteria, for which not many new antibiotics are being developed. (MRSA, by contrast, is a gram-positive bacteria, and there are more drug candidates in the works.)

Dr. Alexander J. Kallen, an expert in antibiotic resistance at the C.D.C., called it "one of a number of very serious bugs we're tracking."

But he noted that a decade ago, New York City hospitals were the epicenter of infections with other bacteria resistant to carbapenem antibiotics. Those bacteria, which had a different mutation, were troubling, but did not explode into a public health emergency.

Drug-resistant bacteria like those with the NDM-1 mutation are usually a bigger threat in hospitals, where many patients are on broad-spectrum antibiotics that wipe out the normal bacteria that can hold antibiotic-resistant ones in check.

Also, hospital patients generally have weaker immune systems and more wounds to infect, and are examined with more scopes and catheters that can let bacteria in.http://www.nytimes.com/2010/08/12/world/asia/12bug.html?_r=1&ref=asia

 

[SHASH2K2]

Superbug alert springs govt into action
The emergence of the antibiotics-resistant 'superbug' and its linking to India has sprung the government into action. The National Centre for Disease Control (NCDC), a nodal agency under the health ministry, is meeting on Thursday to discuss the crisis.

Secretary (health research) V.M. Katoch told agencies that the government was surprised over the superbug being linked to India. A reply on the alert issued by the UK was being drafted.

"We will soon draft a reply to this," Katoch told agencies. "It is unfortunate that this new bug, which is an environmental thing, has been attached to India. I am surprised. This is present in nature. It is a random event and cannot be transmitted."

Resistance to antibiotics means any infection carried by the superbug is incurable. Already 37 cases of the superbug's incidence have been reported in Britain. Most of the patients were those who had travelled to India or Pakistan for medicare.

Other than the UK, cases of superbug infection have also been reported in the US, the Netherlands, Australia and Canada.

Former health minister C.P. Thakur said the superbug theory was a "conspiracy" against India. "It's is not as if people coming here for treatment will go back with this infection. These are all unscientific claims. Because of the medical tourism boom, this could be an attempt to defame the country," Thakur said.

The superbug carries the scientific name of New Delhi metallo-beta-lactamase or NDM-1. Its threat has engulfed India as well, with NDM-1 being found in over 100 patients across a dozen cities.

Besides Delhi, where it was first isolated, NDM-1 has spread to Chennai, Mumbai, Varanasi, Guwahati, Bangalore, Pune, Kolkata, Hyderabad, Rohtak and Port Blair.

The nomenclature of the superbug has left Indian doctors enraged. They are playing down the threat of the superbug and claim that western countries are exaggerating things.

NDM-1 was first identified in two bacteria in 2009 by Dr Timothy Walsh of Cardiff University. The bacteria were taken from a Swedish patient of Indian origin who had been treated in a leading corporate hospital in Delhi.

According to scientists, the enzyme is extremely mobile and can jump from one bacteria to another in the environment. It just pumps out antibiotics from pathogens. That's how several bacteria have been rendered resistant to drugs.

The NDM-1 gene was found on plasmids, which are DNA structures that can be easily copied and transferred between bacteria. This suggests an alarming potential to spread and diversify among bacterial populations.
http://indiatoday.intoday.in/site/Story/108741/World/superbug-alert-springs-govt-into-action.html

 

[samarsingh]

Economic dirty tricks to harm the medical tourism to India, also a way to target the Indian Pharma Industry. This is the "special relationship" Cameron was on about.

 

[LETHALFORCE]

These superbugs have been around for decades in the west from antibiotic misuse and overuse Typical ok UK to try to link it to India. They are fearing that if medical tourism gets to big too much revenue will be lost in a time when the Govt in UK is geting squeezed between rising health care cost declining quaity of healthcare and a crumbling economy.

 

[SHASH2K2]

Need to probe if 'ulterior' motives behind superbug claim: Govt
Incensed by reports that a drug resistant superbug has been traced to India, Government on Friday said there was a need to find out whether some "ulterior motives" were behind the claim.

"We are all concerned about it. Superbug is a global phenomenon. It is not area or country specific. I can tell you this with all the responsibility under my command," Minister of State for Health Dinesh Trivedi told reporters outside Parliament.

"You have read that Kumarswamy Kartikan, one of the co-authors of the report has denied, he has disassociated, from this report," the minister said.

Trivedi said the country cannot take the reports lying down and ought to get to the depth of it.

"...obviously, we have to find out if there are some kind of ulterior motives or not of some pharmaceutical industries as well. I personally feel that sometimes, some things are commercially motivated. So we ought to get into the detail and depth of it. As a country we cannot take anything lying down."

He said as far as drug resistance is concerned, it was a "separate issue".

The Minister also strongly objected to naming the bug after New Delhi.

"It is like HIV. As far as my information is, the first patient of HIV was in America. Can we say it has originated in America. So instead of HIV, can we say America NMD or something like that," he said in dig at western researchers.
http://indiatoday.intoday.in/site/Story/108925/World/need-to-probe-if-ulterior-motives-behind-superbug-claim-govt.html

 

[Phenom]

This is not surprising, whenever a new order tries to replace an older one, the old order would fight back. The rise of India as a medical destination is a serious threat to the established order of hospitals and Pharma in the west, so obviously they have tried to curtail it . This isn't the first time such a thing has happened, earlier when India started becoming a major force in textiles, a huge barrage of articles came out about forced labour and child labour in Indian textile workshops and such bad publicity even managed to harm Indian textile exports for a small amount of time.

In this case the govt and the medical fraternity in India should take every possible step to make sure this kind of negative publicity doesn't harm the growing medical tourism sector.

 

[Logan]

SO now what the NATO countries are going to attack India on the pretext that India is spreading bacteria.
Truly going by the reputation of the westerners anything is possible.............LOL :emot15:

 

[SHASH2K2]

SO now what the NATO countries are going to attack India on the pretext that India is spreading bacteria.
Truly going by the reputation of the westerners anything is possible.............LOL :emot15:

They are just trying to discourage medical tourism .

 

[ajtr]

Fears of a new superbug from Asia may be overblown, experts say​

British researchers said Tuesday that a new bacterium resistant to most antibiotics is becoming more common in India and Pakistan and that it has been identified in 37 people in the U.K., primarily among people who have traveled to that region to receive cheaper medical care. U.S. authorities say that three cases of the infection have also been detected in this country. The outbreak is concerning, the researchers reported online in the journal Lancet Infectious Diseases, because the bug is resistant to a family of newer antibiotics called carbapenams, which are generally reserved for treating bacteria resistant to most other antibiotics.

However, experts said there is no evidence that the new resistant organisms, powered by a mutant gene called NDM-1 that confers resistance, is any more dangerous that the methicillin-resistant Staphylococcus aureus (MRSA) that has become widespread in the United States or any of a number of other carbapenam-resistant organisms that have been observed previously. The new organism is simply "one of a number of very serious bugs we're tracking," Dr. Alexander J. Kallen of the Centers for Disease Control and Prevention told the New York Times. He said the CDC has observed no more new cases in this country since its initial warning in June.

Experts also said that there are at least two older antibiotics that can attack carbapenam-resistant organisms: colistin, which may have some side effects, and Tygacil, manufactured by Pfizer. Pharmaceutical companies are also developing a number of other new antibiotics, a market that is currently viewed as potentially lucrative.

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In the Lancet study, researchers headed by Dr. Timothy Welsh from Cardiff University collected specimens from hospitals and community medical centers in Bangladesh, India and Pakistan. The team found the mutant gene in 36 samples of Escherichia coli, one of the most common causes of urinary infections, and in 111 samples of Klebsiella pneumoniae, which causes lung infections. The mutant strains were resistant to all antibotics except Tygacil and colistin, and some samples were resistant to those as well. The team said nothing about the fate of the infected patients.

India and Pakistan have developed some excellent hospitals and surgeons that provide medical care and surgical procedures, especially elective procedures, more cheaply than they are available in the West. But the overuse of antibiotics among the larger population leads to the development of resistance, and those organisms can make their way into even the best hospitals.

For the moment, most people agree, the new organisms are not an immediate threat in the West. But authorities caution that anyone who becomes ill after visiting Asia for medical procedures should be carefully screened for the new organisms.