Superbug: 'Lancet doesn’t publish rubbish, threat is real'

New Delhi/Lucknow: A day after the Government slammed The Lancet report on NDM-1, the drug-resistant “superbug” originating from India, lead researcher of the study Prof Timothy R Walsh of Cardiff University said the government should instead investigate the matter and recognise this health threat.

"We are unhappy about the personal attacks after this report," Walsh told The Indian Express from Cardiff, "but we want to make clear that Lancet is not in the habit of publishing rubbish. The conclusions that we draw are rational and well-balanced."
Countering the criticism over naming the bug after New Delhi -- New Delhi metallo-beta-lactamase-1 -- Walsh said that this wasn't an unusual practice.
"We named the bacteria NDM-1 because the original patient who was investigated had flown back to Sweden from India with the infection. It was known that the origin of the infection was India and not Sweden. (It was) in the tradition of naming these types of bacteria after the city of origin," he said.

For example, the Verona Integron encoded metallo-beta-lactamase 1 (VIM1) was first reported in Verona, Italy, in 1997 in Pseudomonas aeruginosa, a very common bacteria reponsible for hospital-acquired infection, mostly found in burn and post-surgical infections. The gene was later traced in Greece, France, South Korea, Taiwan, Venezuela, Japan, Belgium etc.
The Sao Paulo Metallo-beta-lactamase1 (SPM1) was first isolated in Sao Paulo, Brazil, in 1997 in the same bacteria. The German Imipenemase1 (GIM1) was isolated in Dusseldorf, Germany, in 2002 and was reported in a research paper published in 2004. And the Seoul Imipenemase (SIM) was a gene reported in Seoul.
On the Government's claim that the report is meant to dent the medical tourism business here as it advises people against going to India for corrective surgeries, Walsh clarified: "If people want to go for surgeries to any country that is up to them. We have just advised that those funded by the British government should be careful. Seventeen of 37 patients in the UK travelled to India and got infected. How can we shut our eyes to this? In fact, it becomes the moral obligation of the Indian Government to recognise this resistance. These conclusions have been drawn based on NHS patients only."

Saying that Indian researchers were fully in the loop before the study was published, Walsh said he had a declaration from all co-authors that "they have read the paper and happy with the contents." The final draft (a copy of the full paper) was sent to the Indian researchers on July 12 and July 13 and nobody raised any objection. "We also have clear evidence in the form of emails that these authors did see final versions of the paper and they signed their agreement with its content and findings. (July 27 and July 29)."
While Union Health Minister Ghulam Nabi Azad criticised the report, its authors stood by their data and findings. One of them, Kartikeyan K Kumarasamy, admitted that "Lancet is scientifically correct and the draft was shown to us all before they published it." He said that he "did not notice the paragraph which cautions people from visiting to India for corrective surgeries."

Anil V Kumar (co-researcher) from the Department of Microbiology, Amrita Institute of Medical Sciences, Kerala, said that the study is invaluable for the Indian health establishment. "If they had not spent their time and money here, we would not have known about the presence of superbug ever. Earlier, too, they have given names to bacteria after cities but nobody has made such a fuss. They have given the name to identify it, there should not be any hard feelings," he said.
According to the study, NDM-1 positive bacteria are around 89-100 per cent susceptible to an antibiotic called colistin and 56-67 per cent susceptible to another antibiotic called tigecycline. In other words, these two antibiotics work on or kill NDM-1 positive bacteria.
Colistin, which gave the best results, was tested on NDM-1 positive bacteria at Pandit B D Sharma PG Institute of Medical Sciences at Rohtak in Haryana and at the University of Madras in Chennai. At Rohtak, the bacteria was found to be 100 per cent susceptible to colistin. In Chennai, it was found 94 per cent susceptible. However, the problem with colistin is that it is not considered safe and used as a last resort.

Doctors say that bacteria developing resistance to certain antibiotics is nothing knew. "This has been happening ever since bacteria developed resistance against the first antibiotic penicillin in 1940s. Regulating the antibiotic policy in the country will also help in containment of the resistant bacteria," said Gopal Nath, professor of Microbiology at BHU.
The Lancet study says that NDM-1 positive bacteria are resistant to carbapenems, which are the latest antibiotics. Nath said this wasn't surprising. "Carbapenems were introduced some time in 2001 and research on NDM-1 began in 2003", he said.
His colleague, Dr M R Sen, who led one of the six teams of researchers that contributed to the Lancet study, said that the problem with NDM-1 was that the gene was found in E. Coli which is a very common bacteria and is resistant to even the latest antibiotics.
Sen, however, disagreed with the recommendation in the paper advising patients against going to India for elective, cosmetic surgeries. "Such a recommendation seems pointless and wrong...such an occurrence could have happened anywhere and for that matter, the gene is already traced in other parts of the world, including UK."