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India Refutes Claims Linking New Superbug to Medical Tourism

First known NDM-1 fatality occurs in Belgium

By Katherine Krampol Created: August 19, 2010 Last Updated: August 19, 2010
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A microbiology specialist at Brussels University Hospital holds up a dish of bacteria culture on August 13. A Belgian man died from drug-resistant NDM-1, the first reported death from the bacteria, after becoming infected while being treated in a hospital (Benoit Doppagne/AFP/Getty Images)

A microbiology specialist at Brussels University Hospital holds up a dish of bacteria culture on August 13. A Belgian man died from drug-resistant NDM-1, the first reported death from the bacteria, after becoming infected while being treated in a hospital (Benoit Doppagne/AFP/Getty Images)

Amid fears that a new superbug could spread worldwide, the Indian government is objecting to international media and medical reports linking the antibiotic-resistant gene to India and its health care facilities.

International travel and India’s own medical tourism industry are currently being blamed for the rise and global spread of New Delhi metallo-beta-lactamase, known widely as NDM-1, a superbug showing alarming resistance to some of the most powerful antibiotics available.

In a press release issued by Indiatourism Toronto, Dr. V.M Katoch, director general of Indian Council for Medical Research, called associating the bacteria with India “misleading” and “unfair,” saying superbugs have been reported in countries like Greece and Israel, and also survives in nature.

“The Government of India has strongly refuted the naming of this enzyme as New Delhi-metallo-beta-lactamase and also refutes the reports that hospitals in India are not safe for treatment including medical tourism,” the release said.

The release went on to explain that superbugs are more prevalent throughout the world due to international travel, and citing “isolated examples” to show that the presence of the superbug in India makes the country an unsafe place to visit is misleading.

Dr. Timothy Walsh, a medical professor at Cardiff University in Wales, first identified NDM-1 after a Swedish man hospitalized and treated unsuccessfully in India for pneumonia and E.Coli returned home with the antibiotic-resistant bacteria.

Upon investigation, Professor Walsh and his researchers discovered both bacteria were carrying a common gene (NDM-1), an enzyme highly resistant to carbapenems, a class of antibiotics considered last-resort treatment for bacterial infections such as E.coli.

Walsh and his colleagues reported their findings in the Lancet, a journal for infectious diseases, citing that the gene was showing multi-drug resistance which could potentially create a “major global health problem.”

The report called for “co-ordinated international surveillance” to prevent the superbugs’ spread.

A Belgian man died in June after becoming infected while hospitalized in Pakistan, making him the first known fatality of NDM-1, Belgian media reported last week. The unidentified man became infected after being involved in a car accident during a trip to Pakistan. Colistin, a powerful antibiotic, was unable to thwart the infection.

Most cases of the superbug have been detected in India, Pakistan, and the U.K., with a few cropping up in the U.S., Sweden, the Netherlands, Australia, and Canada. The two reported cases in Canada, in Alberta and B.C., were successfully treated.

However, medical scientists fear that the antibiotics being used to treat the bacteria will soon become ineffective.

“In many ways, this is it,” Walsh told the Guardian, “This is potentially the end. There are no antibiotics in the pipeline that have activity against NDM 1-producing Enterobacteriaceae.”

Walsh warned that a window of about ten years exists before the bacteria becomes fully resistant to treatment, forcing the global community to deal with the potential end to antibiotics for Enterobacteriacae infections.

“It is the first time it has got to this stage with these type of bacteria,” he said.

Dylan Pillai, a medical microbiologist at the Ontario Agency for Health Protection and Promotion, is no more hopeful.

“It’s quite concerning because there are very limited treatment options,” he told the Globe and Mail. “We’re really in a tight spot here.”

Several media reports indicate that patients contracted the bacterial gene after undergoing medical treatment in hospitals on the Indian subcontinent, a popular destination for patients requiring procedures such as bone marrow transplants, dialysis, and cosmetic surgery.

But India’s Ministry of Health rejects the claim and strongly objects to naming the enzyme after New Delhi, India’s capital city.

A spokesperson for India’s Ministry of Tourism maintains that the country’s world class medical facilities, manned by highly qualified doctors, have made India one of the world’s top medical health care destinations.

“India remains a safe and preferred medical tourism destination,” the spokesperson said.

Nevertheless, British and Canadian medical professionals are calling for utmost vigilance when dealing with patients who have undergone medical treatment in India.

In the Lancet report, Johann D.D. Pitout, a University of Calgary professor of pathology and laboratory medicine, suggests screening patients who have undergone medical treatments abroad before admitting them for hospital care following their repatriation. This would help curb the spread of the superbug within their own health care facilities.

Katherine Krampol is a writer and blogger living in Vancouver.




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