Superbug in New Delhi

Antibiotic resistance is a type of drug resistance where microorganisms especially bacteria are able to survive exposure to an antibiotic. The primary cause of antibiotic resistance is genetic mutation in bacteria. The prevalence of antibiotic resistant bacteria is a result of unsupervised use of antibiotics or use of too many antibiotics by careless physicians without much rationale in order to treat the infection quickly. The greater the duration of exposure the greater the risk of the development of resistance irrespective of the severity of the need for antibiotics.  The production of β-lactamases in Gram-negative bacteria, is a serious bacterial resistance problem worldwide. If a bacterium carries one or several resistance genes, it is called, informally, a superbug or super bacterium. Antibiotic resistance poses a significant health problem, as in some cases, people infected with resistant bacteria can not be treated effectively by wide variety of antibiotics which could ultimately lead to fatalities.

Until late 90s, antibiotic resistance was not very fashionable beyond clinicians and researchers with first-hand knowledge of the topic. However, now that it is the focus of WHO's World Health Day on April 7, resistance has joined the front rank of global health concerns. What has brought antibiotic resistance into the limelight, and can this new-found status be harnessed to “safeguard these medicines for future generations”, to use the words of the World Health Day website? Recent studies have identified extended-spectrum β-lactamases in high proportions in enterobacteria from India; faced with this problem, the use of reserved antibiotics such as carbapenems has become necessary.

Last year, there was a study published in Lancet which reported the presence of superbug (antibiotic resistance bacteria) in the British patients that had been treated in India. It is important to note that India is fast becoming a hub for medical tourism given its cheaper and good quality health services especially for those who can not afford to have treatment in western health system due to financial constraints. However, government of India and several health experts in India rejected that study based on some technical flaws in the study and also because they thought this study could be biased and politically motivated to discourage rapidly growing health industry in India. Now this another study again by a British group, forces us to take this problem more seriously rather than rejecting as this time they reported the presence of NDM-1 β-lactamase-producing bacteria in environmental samples in New Delhi has important implications for people living in the city who are reliant on public water and sanitation facilities. Researchers collected samples by swabbing seepage water such as water pools in streets  and public tap water from sites within a 12 km radius of central New Delhi, with each site photographed and documented and then analyzing them for the presence of the NDM-1 gene, blaNDM-1, by molecular detection methods.

Though only small percentage of these samples were tested positive for superbug, implications of these results for people living in the Delhi city who are reliant on public water and sanitation facilities are far more serious. International surveillance of resistance, incorporating environmental sampling as well as examination of clinical isolates, needs to be established as a priority. Of course as true with many scientific studies, this study is also not flawless; as microbiologists can certainly comment on the technical issues, but no one would disagree that now health regulatory boards and health policy makers in the countries where they have no or less regulation on the use of antibiotics, should wake up and implement the necessary measures. It is a common practice in India (except few big metropolitan cities) that people go to a pharmacy and ask for an antibiotic of their choice to treat their common health problem, some of these short term health conditions  may not even need antibiotics as there is no bacterial infection yet such as seasonal cold/fever or viral gastroenteritis. This practice should immediately be stopped irrespective of results and intention of recent  Lancet study.  

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70059-7/abstract#