Lill-Karin Skaret, a 67-year-old grandmother from Namsos, Norway, was traveling to a vacation villa near India’s port city of Kochi in March 2010 when her car collided with a truck. She was rushed to the Amrita Institute of Medical Sciences, her right leg broken and her artificial hip so damaged that replacing it required 12 hours of surgery.
Three weeks later, Skaret was relieved to be home. Then her doctor gave her upsetting news. Mutant germs that most antibiotics can’t kill had entered her bladder, probably from a contaminated hospital catheter in India. She risked a life- threatening infection if the bacteria invaded her bloodstream -- a waiting game over which she had limited control, Bloomberg Markets magazine reports in its June issue.
“I got a call from my doctor who told me they found this bug in me and I had to take precautions,” Skaret remembers. “I was very afraid.”
Skaret was lucky. Eventually, her body rid itself of the bacteria, and she escaped harm from a new type of superbug that scientists warn is spreading faster, further and in more alarming ways than any they’ve encountered. Researchers say the epicenter is India, where drugs created to fight disease have taken a perverse turn by making many ailments harder to treat.
India’s $12.4 billion pharmaceutical industry manufactures almost a third of the world’s antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune, thwarting even high-powered antibiotics, the so-called remedies of last resort. As the superbacteria take up residence in hospitals, they’re compromising patient care and tarnishing India’s image as a medical tourism destination.
“There isn’t anything you could take with you traveling that would be useful against these superbugs,” says Robert Moellering Jr., a professor of medical research at Harvard Medical School in Boston.
More than 40 countries have discovered the genetically altered superbugs in blood, urine and other patient specimens. Canada, France, Italy, Kosovo and South Africa have found them in people with no travel links, suggesting the bugs have taken hold there.
Drug resistance of all sorts is bringing the planet closer to what the World Health Organization calls a post-antibiotic era. “Things as common as strep throat or a child’s scratched knee could once again kill,” WHO Director-General Margaret Chan said at a March medical meeting in Copenhagen. Current varieties of resistant bacteria already kill more than 25,000 people in Europe annually, the WHO says.
“If this latest bug becomes entrenched in our hospitals, there is really nothing we can turn to,” says Donald E. Low, head of Ontario’s public health lab in Toronto. “Its potential is to be probably greater than any other organism.”
The new superbugs are multiplying so successfully because of a gene dubbed NDM-1. That’s short for New Delhi metallo-beta- lactamase-1, a reference to the city where a Swedish man was hospitalized in 2007 with an infection that resisted standard antibiotic treatments. The NDM-1 gene is carried on mobile loops of DNA called plasmids that transfer easily among many types of bacteria. What’s worse, germs empowered by NDM-1 can muster as many as nine other ways to destroy the world’s most potent antibiotics.
NDM-1 is changing common bugs that drugs once easily defeated into untreatable killers, says Timothy Walsh, a medical microbiology professor at Cardiff University in Wales. Or as in Skaret’s case, the gene is creating silent stowaways poised to attack if they find a weakness -- or that can pass harmlessly when the body’s conventional microbes win out.
India is susceptible because it has many sick people to begin with while poor sanitation increases the scope of antibacterial resistance. Abdul Ghafur, an infectious diseases doctor in Chennai, used to combat infections with such common antibiotics as amoxicillin. Now he uses more-expensive ones that target a broader range of germs but typically cause greater side effects. Some infections don’t respond to any treatment, evading all antibiotics, he says.
“There is a tsunami that’s going to happen in the next year or two when antibiotic resistance explodes,” says Ghafur. “We need wartime measures to deal with this now.”
R.K. Srivastava, India’s former director general of health services, says the government is giving top priority to antimicrobial resistance. At the same time, it’s trying to preserve the country’s health-tourism industry. Bristling that foreigners coined a name that singles out their capital, officials say the world is picking on India for woes that impede all developing nations.
Even though Skaret, the Norwegian grandmother, escaped physical harm, she says NDM-1 made her feel isolated. Therapists refused to help her with rehabilitation. Neighbors were careful not to get too close, she says.
Cardiff’s Walsh projects 100 million Indians may be carrying the NDM-1 gene unwittingly, doing little to contain its spread. Countries reporting NDM-1 will increase as more bacteria pick up the gene and people transport it around the globe.
To prevent a worldwide catastrophe, scientists and doctors are sounding an alarm.
“Combine sophisticated medicine, poor sanitation and heavy antibiotic usage, and you have a rocket fuel to drive the accumulation of resistance,” says David Livermore, who heads antibiotic resistance monitoring at the U.K.’s Health Protection Agency in London. “That surely is what India has created.”
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