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

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India trashes 'superbug' report, says it's doctored​

CHENNAI: A day after the Lancet report on drug-resistant 'superbug' NDM-1 created a global scare, India has hit out at the study, which it said was funded by pharma companies that make antibiotics to treat such cases.

While the Union health ministry issued a statement on Thursday which also takes offence to the naming of the bug after the national capital, the paper's Chennai-based lead author Karthikeyan Kumarasamy dissociated himself from parts of the report.

"The study was funded by the European Union and two pharmaceutical companies, Wellcome Trust and Wyeth, which produce antibiotics for treatment of such cases. It also needs to be highlighted that several of the authors have declared conflict of interest in the publication," the health ministry said.

Doctors have criticised the report, saying it appeared to be aimed at hitting at India's booming medical tourism that was taking away business from the West.

Kumarasamy said he had not written many of the interpretations in the report; they were added later without his permission or knowledge. "I do not agree with the last paragraph which advises people to avoid elective surgeries in India. While I did the scientific work, correspondence author Timothy R Walsh of Cardiff University was assigned to edit the report," Kumarasamy told TOI.

According to the study based on a survey of patients in Indian cities, a multi-drug resistant strain of bacteria was spreading from Indian hospitals. The bug entering the blood stream through infected hospital equipment could lead to multiple organ failure, said the researchers. However, experts had alleged a bias in the findings and said such infections could originate anywhere.

Writing to the report's co-author Walsh on Thursday, Kumarasamy's guide at University of Madras Padma Krishnan said the report would "create boundaries" between scientists. "The research was taken up in the interests of patient care, but the report has projected a negative image of India," she added.

Walsh has been quoted in British media as advising people to "think long and hard" before making a decision to undergo treatment in Indian hospitals. Incidentally, the Lancet report comes close on the heels of International Society of Aesthetic Plastic Surgery ranking India among the top five destinations for cosmetic surgery. Walsh was not reachable over the phone.

Kumarasamy said the report pained him. "It was too small a sample to extrapolate. My intention was to find out whether such multi-resistant bacteria existed in India. We see several such strains of multi-drug resistant bacteria across the world," Kumarasamy added.

Read more: India trashes 'superbug' report, says it's doctored - India - The Times of India http://timesofindia.indiatimes.com/...octored/articleshow/6301982.cms#ixzz0wYCjR2Ip

 

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UK doctor reiterates superbug's origin

British researchers-at the centre of the row over their finding relating to a gene that renders antibiotics ineffective-reiterated on Saturday that the gene named after New Delhi indeed originated in the city.

They also denied any conflict of interest in their study.

"The patient in which the resistance was first identified contracted the resistant strain through travel to New Delhi. The infection was established in India prior to relocation back to Stockholm," Dr Timothy R. Walsh, professor of medical microbiology and antimicrobial resistance at Cardiff University's School of Medicine, said in an interview.

Indian health officials and doctors have been alleging that the Swedish national might have acquired the infection elsewhere and not in Delhi.

The gene's name, New Delhi metallo-beta-lactamase or NDM-1, was given for the first time in a presentation made at the international conference on antibiotic agents and chemotherapy held in Washington in October 2008.

Subsequently, detailed research findings were reported in a scientific journal called Antimicrobial Agents and Chemotherapy in 2009.

After this, research groups in Mumbai and Delhi took up independent studies-the first such was reported in the Journal of Association of Physicians of India. Clearly, the scientific community in India was aware about the naming of NDM-1 after New Delhi and there were no protests of any sort in the past two years.

On Saturday, Dr Walsh also brushed aside charges of conflict of interest articulated by the health minister, the Indian Council of Medical Research and the medical tourism industry.

The conflict of interest was declared in the paper itself. He said the bulk-about 98 per cent-of the study funding came from the European Union and Wellcome Trust, which is a charity and not drug company, while Wyeth (which has been acquired by Pfizer) provided only 2 per cent.

"Wyeth only sponsored (Chennai researcher) Karthik Kumaraswamy's travel to the UK under an educational fellowship to come to our lab and learn some techniques," Dr Walsh said.

"The company was not offered any information prior to the publication of the paper and has had no influence over any data or the way it was presented. Nor has it received any isolates from the study," he added.

Asked if Wyeth manufactured any antibiotic that could be effective against NDM-1, as alleged by the doctors in India, Dr Walsh said: "The antibiotic most consistently active against these bacteria-Colistin-is long out of patent and unlikely to be profitable to any one company."

As regard to another antibiotic, tigecycline, that Pfizer makes, he said: "You will note from our study that there are some strains even resistant to tigecycline and there are some infections for which this antibiotic is not licenced. To think we can just fall back on tigecycline (for those strains that are sensitive) and colistin to treat the NDM-1 bacteria ad infinitum is crazy. Resistance will invariably occur so we desperately need new drugs."

On allegations by Indian authors that they were not shown the final version of the paper and the concluding statement about the NHS patients travelling to India for surgery, Dr Walsh said he was "surprised and saddened", and added that "they (Indian collaborators) may have been under some pressure". He said the statement in question had been an integral part of the paper since March and all authors had signed their agreement with its content and findings.

"We also have clear evidence in the form of emails that these authors did see final versions of the paper and agreed with it," Dr Walsh said.

 

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http://www.ndtv.com/news/videos/video_player.php?id=158342

 

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Mumbai docs reported superbugs months before Lancet study

Researchers in a Mumbai hospital had reported presence of a multi-drug resistant superbug in an article published in an Indian medical journal, months before the Lancet study that has caused an outrage in the country's medical fraternity and drawn criticism from the government.

A team of researchers from Department of Medicine at P D Hinduja National Hospital and Medical Research Centre -- Payal Deshpande, Camilla Rodrigues, Anjali Shetty, Farhad Kapadia, Ashit Hedge and Rajeev Soman -- had in March this year warned about the superbug in the Journal of the Association of Physicians of India (JAPI).

The Lancet article, however, did not cite this paper in its issue and quoted only the editorial which appeared in JAPI.

Hinduja researchers had come to the conclusion after noticing 22 instances of New Delhi Metallo-lactamase-1 (NDM-1) in 24 patients between August and November last year.

"This high number in a relatively short span is a worrisome trend that compromises the treatment options with carbapenems (a type of antibiotics used against multi-drug resistant infections)," the article in JAPI said.

According to medical experts, superbugs or any other microbes are present everywhere and are not specific to any city, country or religion.
http://indiatoday.intoday.in/site/Story/109009/World/mumbai-docs-reported-superbugs-months-before-lancet-study.html

 

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Delhi superbug is new global health threat


The latest threat to your health has New Delhi as its first name. A new enzyme discovered in the city is turning a number of disease- causing bacteria into superbugs, posing a new threat to global health.

The enzyme called 'New Delhi metallo- beta- lactamase' or NDM-1 makes several serious infections antibiotic-resistant. It has been isolated from bacteria that cause a number of diseases ranging from urinary tract infection to pneumonia. It can make all of them resistant to topline antibiotics, rendering them useless and leaving you with no cure.

What is alarming is that the new threat is not limited to hospitals or to one city. NDM-1 has already been found in over 100 patients who suffered various bacterial infections in a dozen cities across the country and has even spread to the UK, the US, the Netherlands, Australia and Canada through people who had travelled to India for surgery or treatment.

The enzyme is "extremely mobile", scientists said. It can jump from one bacteria to another in the environment. That's how several bacteria have been rendered resistant to drugs.

The NDM- 1 gene was found on plasmids - DNA structures that can be easily copied and transferred between different bacteria - suggesting "an alarming potential to spread and diversify among bacterial populations". The transmissibility and plasticity of NDM-1 implies there could even be outbreaks of NDM- 1 carrying bacteria in communities.

Even more disturbing is the fact that most of the India isolates from Chennai and Haryana were from community acquired infections, suggesting that NDM- 1 is widespread in the environment, pointed out Dr Mark A Toleman, one of the co-authors of the study.

Experts said since NDM- 1 makes bacteria resistant to antibiotics which are considered last treatment option for several infection, morbidity and mortality due to these infections could significantly go up.

Besides Delhi from where it was isolated first, NDM- 1 has spread to Chennai, Mumbai, Varanasi, Guwahati, Bangalore, Pune, Kolkata, Hyderabad, Rohtak and Port Blair. In Pakistan, it has been found in eight cities and in Dhaka as well.

"The rapid emergence of multi- drug resistant NDM-1 producing bacteria and their potential worldwide spread could herald a period in which antibiotics could become redundant," researchers from India, the UK and Pakistan warned on Wednesday in a study published in scientific journal The Lancet Infectious Diseases.

"We need to urgently start very close international monitoring and surveillance." In 2009, Dr Timothy Walsh from Cardiff University in the UK had first identified NDM- 1 in two bacteria - Klebsiella pneumoniae and Escherichia coli taken from a Swedish patient of Indian origin admitted to a leading corporate hospital in Delhi. Worryingly, NDM-1-producing bacteria are resistant to many antibiotics including a group of antibiotics known as carbapenems, which are usually reserved for use in emergencies and the treatment of infections caused by multi-resistant bacteria.

"The NDM- situation is likely to get substantially worse in the foreseeable future. It is of great concern because there are very few antibiotics in the pharmaceutical pipeline and none that are active against NDM-1," said Dr Walsh, who led the research team which included scientists from Indian medical colleges and Apollo hospitals.

Indian microbiologists too are worried. "It is an extremely serious situation and our health authorities are not able to realise the gravity of it. We are seeing a number of patients with resistance to antibiotics every day," commented Dr Chand Wattal, head of clinical microbiology at Sir Ganga Ram Hospital.

"This is the metabolic response of pathogens to antibiotics," Dr Wattal said. "Unbridled use of antibiotics has led to this situation.

NDM- 1 just pumps out antibiotics from pathogens." The researchers collected bacteria samples from Indian hospital patients and those suffering from community associated infections, and from patients referred to the UK's national reference laboratory between 2007 and 2009.

Samples were tested for antibiotic susceptibility and the presence of the NDM-1 gene using a technique called the polymerase chain reaction.

The gene was isolated from four per cent of 3,521 samples from Chennai that were analysed. It was present in 24 per cent of the samples collected from Post Graduate Institute of Medical Sciences, Rohtak. These isolates, scientists said, were primarily from community acquired urinary tract infections, pneumonia and bloodstream infections.

The new discovery could spell doom for the lucrative medical tourism business. Several of the British NDM-1 positive patients had travelled to India or Pakistan for surgical procedures including cosmetic surgeries within the past year. Since India also provides cosmetic surgery for other Europeans and Americans, it is likely NDM- 1 will spread worldwide, scientists warned.

Dr Johann Pitout from the University of Calgary in Canada has cautioned that patients who have medical procedures in India should be screened for multiresistant bacteria before they receive care in their home country.

"If this emerging public health threat is ignored, sooner or later the medical community could be confronted with drug- resistant bacteria that cause common infections, resulting in treatment failures with substantial increases in healthcare costs."

 

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100 patients and it is making headlines because it is India, Vancomycin resistance kills thousands in other countries without one article. Even more interesting Chennai and Harayana are not the big medical tourism locations.

 

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Three people from India infected with 'superbug': US group

BOSTON: Three people, who returned to the US from India earlier this year, have been infected with the "superbug" that are highly resistant to antibiotics, the US Centers for Disease Control and Prevention has said. All three confirmed US cases - in Massachusetts, California and Illinois - involved people who had received medical care in India.

A person infected with the 'superbug' was treated earlier this year at Massachusetts General Hospital and isolated, a move that helped prevent the germ from spreading.

The patient had recently travelled from India.

The Illinois patient too recovered, and there is no evidence the infection was transmitted to other people.
The US Centers for Disease Control and Prevention said the Massachusetts patient survived, as did the only other two US patients with infections.

All three patients developed urinary tract infections that carried a genetic feature that made their cases harder to treat.

The superbug, also known as NDM-1 - short for New Delhi metallo-beta-lactamase -– allows bacteria to escape some of the strongest antibiotics available.

"It leaves treating physicians with few treatment options," the Boston Globe quoted Alex Kallen, a CDC medical officer, as saying.

All three of the US patients had been in India, and two underwent medical procedures in hospitals while they were there, Kallen said.

The patient treated in Boston was an Indian citizen with cancer who had undergone surgery and chemotherapy in that country before coming to Massachusetts, Kallen added.

Cases of NDM-1 infections have been reported in Asia, Europe and Canada. Experts have said the threat posed by the germs in the US is most acute in hospitals.

"They don't cause infection in people walking down the street," said Dr Alfred DeMaria, top disease tracker for the Massachusetts Department of Public Health.

"If somebody is in an intensive care unit on a ventilator with a tube in their trachea, they are at risk for these organisms. If someone has had extensive abdominal surgery with lots of open wounds, they are at risk."

Only two antibiotics possess a measure of effectiveness against bacteria riddled with NDM-1, doctors said: an old drug called colistin, and tigecycline.


Read more: Three people from India infected with 'superbug': US group - The Times of India Three people from India infected with 'superbug': US group - The Times of India

 

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New Delhi' superbug unfairly named, admits editor​

NEW DELHI — The naming of a drug-resistant superbug after New Delhi unfairly stigmatised India, the editor of the medical journal that first published research into the disease has admitted.

The Lancet journal revealed in August the discovery of a superbug that could pose a global threat like Severe Acute Respiratory Syndrome (SARS) or human swine flu.

Researchers named the enzyme "New Delhi metallo-beta-lactamase 1 (NDM-1)" as some victims had recently travelled to India for medical treatment and cosmetic surgery -- but health experts in India were furious at the tag.

"It was an error of judgement," Richard Horton, editor of the London-based Lancet told reporters on Tuesday during a visit to Delhi. "We didn't think of its implications for which I sincerely apologise."

The name "unnecessarily stigmatised a single country and city" and should be changed by researchers, he added.

Indian doctors complained the name incorrectly suggested New Delhi was the origin of the bug -- and some politicians saw a conspiracy designed to scupper the country's booming health tourism industry.

The government health ministry angrily dismissed The Lancet's report as exaggerated and unfair, and publicly complained about the name.

The NDM-1 gene was first identified in 2009 by Cardiff University's Timothy Walsh in two types of bacteria -- Klebsiella pneumoniae and Escherichia coli -- in a Swedish patient admitted to hospital in India.

After The Lancet article, cases were reported in Canada, the United States, Belgium, the Netherlands, Austria, France, Germany, Kenya, Australia, Hong Kong and Japan.

Horton said he stood by the study's research.

India has been criticised in the past for having a loose policy on the use of antibiotics, with the result that they are over-prescribed and over-used to the point where resistant strains become more common.

 

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US help for India's superbug fight​

NEW DELHI: The world's best-known institute for handling bad bugs — Atlanta-based Centre for Disease Control and Prevention (CDC) — will help India strengthen its laboratory and manpower capacity to better detect pathogens like NDM-1 and virus outbreaks.

India can boast of its own version of CDC — a full-fledged National Centre for Disease Control (NCDC) — by next year, and the construction for it will begin within two months. The facility will be equipped with state-of-the-art infrastructure like wet and dry laboratories, highly-advanced bio-safety level-II and BSL-III laboratories. The authorities have set aside Rs 382.41 crore for NCDC.

A three-member high-level team from the Union health ministry — health secretary K Chandramouli, NCDC chief Dr L S Chauhan and joint secretary R S Shukla — was scheduled to visit Atlanta from April 9 to 15 "to study how the iconic institution functions, what are the technologies that will have to be replicated in India and how they carry out disease surveillance". The trip, however, got postponed on Friday.

Union health ministry sources told ToI, "One of the main departments in NCDC will handle microbial and antibiotic resistance. Our MoU with CDC (signed in 2010) entails that it will help us in strengthening our laboratory capacity and expand trained manpower to deal with new pathogens like NDM1 created superbug. CDC will help us in fighting drug resistance, surveillance for remerging infections and capacity building."

NCDC will have 15 exhaustive divisions, which will look at manpower, capacity building, outbreaks, laboratory technology, new pathogens, technology transfer, microbial resistance, drug-resistant TB, vector medicine, microbiology and biochemistry. The facilities at NCDC's eight out-station branches are also being upgraded.

Altogether, 245 additional posts — 210 technical and another 35 administrative openings — will be created for the new Centre by March, 2013.

The state-of-the-art laboratory is the seventh facility being set up by CDC, globally. The new Centre will share outbreak information, coordinate responses and support World Health Organization's Global Outbreak Alert and Response Network to allow rapid identification, confirmation and response to outbreaks of international importance.

The MoU entailed sharing best practices for detection and response to emerging infections, advanced training in field epidemiology, surveillance for deadly diseases and building laboratory capacity for their diagnosis, using CDC's reference materials.

A major focus for the India laboratory will be zoonotic diseases. Approximately 75% of recently identified emerging infectious diseases affecting humans are diseases of animal origin. Additionally, 80% of pathogens — with a high potential for bioterrorism — are zoonotic.

The 2004 programme was funded by Congress in the wake of SARS outbreak. Experience with SARS demonstrated that a highly pathogenic infectious disease in a remote region can spread around the world in a matter of days or weeks.