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.
Process of Genetically Modified Bacteria
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 pneumonia, 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 globalization 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.