Superbug wakes up a sleeping government

Lucknow/New Delhi: The presence of the NDM-1 gene, which alters bacteria and makes them resistant to antibiotics, was detected in India in a study which concluded last year, a study that’s, ironically, being trashed by the Government as “shocking and unscientific.”

Several MPs have also called it an "MNC-pharma conspiracy" to undermine medical tourism in India because the study says the gene has been identified in 37 people who returned to the UK after undergoing surgery in India or Pakistan.
What all of them seemingly glossed over is the fact that six Indian institutes, including the Department of Microbiology at Banaras Hindu University's Institute of Medical Sciences and the Microbiology Department at the University of Madras in Chennai, participated in the study in collaboration with Cardiff University, UK, and Stockholm's prestigious Karolinska University Hospital.

The study was funded by the European Union; Wellcome Trust, a charity that sponsors medical research, and Wyeth, a pharma company now part of Pfizer.
"It is the most unscientific article and I am shocked that Lancet has published it. There is a conflict of interest and there is clearly no science behind it," K Sujatha Rao, Health Secretary told The Indian Express.
Late in 2008, the Antibiotic Resistance Monitoring and Reference Lab of the UK-based Health Protection Agency (HPA) sounded an alarm across the world about the New Delhi metallo-ß-lactamase 1 (NDM-1) gene.
"We found cases of drug-resistant patients in Sir Sunderlal Hospital and we started a study on our own when we found the information about this gene on the net," said Dr M R Sen, professor at the Department of Microbiology of BHU's Institute of Medical Sciences, one of the participating institutions.

Sen said they contacted HPA and decided to test patients for NDM-1. About 300 to 400 patients were screened and 17 samples were selected for genetic analysis. Of these, 13 tested positive for the drug-resistant gene. Since facilities of genetic analysis were then not available in Varanasi, a research scholar Supriya Upadhyay took the samples to the P D Hinduja Hospital and Medical Research Centre in Mumbai. Amitabh Bhattacharya was another researcher involved in the study, said Sen.
At that time, Cardiff University, which had been in touch with HPA, was also working on the gene along with some other Indian institutions. "The British researchers found that the patients had a recent travel history to India and Pakistan. The study was conducted almost simultaneously at various other centres in India," said Dr Sen.

These were: the University of Madras and Apollo Hospital, Chennai; Pandit B D Sharma PG Institute of Medical Sciences, Rohtak, Haryana; Amrita Institute of Medical Sciences, Kerala; Apollo Gleneagles Hospital, Kolkata, and BHU, Varanasi.
Sen said the existence of this gene is common in bacteria like E. Coli (which causes urinary tract infections) and K. Peumoniae (which causes pneumonia). "Though the detection of E. Coli and K. Peumoniae is easy, and even their resistance against common drugs can be tested in a routine way, the trick is to test whether the bacteria is resistant to all antibiotics like carbapenems which is one of the latest antibiotics effective on most of the bacteria", said Sen.
This drug-resistant bacteria first spreads in hospitals and strikes at the community level only at a very later stage, Sen said. He added that if detected early in a patient, the bacteria can be tackled medically. But once the infection spreads, it is difficult to contain it and may cause septicemia in patients, he said.

The DGHS on Thursday held a meeting with the Secretary, Health Research, V M Katoch and Director of National Centre for Disease Control Dr R L Ichhpujani.
"This (the conclusion) is not supported by any scientific data. This occurs in nature and in the intestines of animals and humans universally. Similar strains are found in the US and UK," said Ichhpujani.
Some experts said that such organisms may be circulating more commonly in the world due to international travel and to link this with the safety of surgery in hospitals in India is wrong.

But Dr Anoop Misra of Fortis hospital said he would be careful before trashing the Lancet study. "This is a serious thing and I see no reason for the Lancet to mislead. If the government is of the view that there is no basis to it, the best thing is to independently investigate the matter rather than just rubbishing it," he said.
Adding that the study should be an eye opener as regulations are needed on the use of antibiotics anyways, he said, "There should be an independent policy by each policy on the use of antibiotics."
The Government said the study was funded by the European Union and a pharma company, Wyeth, that produces antibiotics. Said Dr Misra: "The study does no good to the pharma companies as well and Lancet is very strict about these issues. They definitely take in account the funding. I know how professional they are. It is unfair to say there is a conflict of interest."
Source: The Indian Express