India rejects 'New Delhi' superbug study

The study blamed treatment in South Asian hospitals for spread of a superbug

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[NEW DELHI] The Indian government has reacted angrily to scientists' claims that a superbug of potentially international concern is being spread by its hospitals.

A mostly Indian and British team of researchers reported in the Lancet Infectious Diseases this week (11 August) that a gene that makes bacteria resistant even to the most powerful antibiotics is spreading rapidly from India and Pakistan to the United Kingdom and United States, mostly through patients who have undergone treatment in South Asia.

The Indian government yesterday rejected the study's conclusions as "frightening" and not backed by scientific evidence. It also objected to the naming of the gene behind the resistance as 'New Delhi metallo beta-lactamase' (NDM-1).

"The conclusions are loaded with inference that these resistance genes/organism possibly originated in India and it may not be safe for the UK patients to opt for surgery in India," said the government statement. "The concluding sentence presents a frightening picture which is not supported by any scientific data."

The team, whose corresponding author was Timothy Walsh, professor at the Department of Infection, Immunity and Biochemistry, at the School of Medicine, Cardiff University, reported on its investigation of resistant bacteria in patients from India, Pakistan and the United Kingdom.

The group reported that it had isolated the gene NDM-1 from the bacteria. This gene confers resistance to many antibiotics, including the powerful 'carbapenems' that are used as a last resort for bacterial infections and in emergencies.

Many of the UK patients who carried bacteria containing the NDM-1 gene had travelled to India or Pakistan within the past year, or had links with these countries.

The scientists concluded that the resistance is spreading from Indian hospitals and said they "strongly advise against" Western patients travelling to India for corrective surgery.

"The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed," they said.

But India has said that similar resistance threats have been reported from Greece, Israel, and the United States, and it is "wrong to cite isolated examples to conclude that India is not a safe place to travel to".

It also highlighted that funding for some activities of two of the authors came from a pharmaceutical company, something that is declared in the scientific paper.

Meanwhile, the lead Indian scientist behind the report, Karthikeyan Kumarasamy, researcher at the Department of Microbiology, at the University of Madras, told the Press Trust of India that he, too, did not agree with the report's conclusions.

"Without my knowledge some of the interpretations were written in the report," he said.

"That the bacteria was transmitted from our country is just hypothetical. Unless we analyse samples from across the globe to confirm its presence, we can only speculate."

And he told The Times of India: "I do not agree with the last paragraph which advises people to avoid elective surgeries in India. While I did the scientific work, correspondence author Timothy R Walsh was assigned to edit the report".

A senior Indian microbiologist, Sarman Singh, said that the authors should have highlighted other, urgent issues, thrown up by the report.

Singh, who is professor at the Department of Laboratory Medicine at the All India Institute of Medical Sciences, New Delhi, said that Western hospitals have strict drug surveillance systems that allow them to deal with emerging resistance by ordering switches in antibiotic regimes until the bacteria cease to feel the pressure to produce resistance to the old antibiotics.

The study highlights the fact that such regimes are needed in India and other developing nations, through more effective hospital infection control committees, he said. All developing countries are grappling with the problem of increasing antibiotic resistance and need to address these issues, he added.

But he also agreed that use of the term 'New Delhi' was "uncalled for, unnecessary and unscientific".

Link to full paper in The Lancet Infectious Diseases*

Link to a full statement by the Ministry of Health and Family Welfare, India

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