This week saw numerous news stories on a possible new superbug, NDM-1. The first NDM-1 associated death was reportedly a Belgian man who was infected in Pakistan after surgery for a car accident injury. In recent years, rising medical costs in Western countries such as the US and Britain have driven patients seeking more affordable care and procedures to developing countries like India and Pakistan, a phenomenon now known as “medical tourism.” Since December of 2009, bacteria with resistance to nearly all known antibiotics have been found in British, Australian, Canadian, American and Dutch patients who had previously sought care in India. These bacteria contained a gene producing resistance to even the most powerful class of antibiotics (carbapenems). The gene was named New Delhi Metallo-beta-lactamase (NDM-1) after the city where it was believed to have originated. A study published in The Lancet in early August found NDM-1-carrying bacteria to be common in hospitals in India, Bangladesh and Pakistan and even more prevalent among the local community, where it can spread easily through contaminated water. A backlash against the news coverage has taken two forms: scientific and political. Some scientists are concerned that the media hype suggests NDM-1 is a spectacular concern even though other antibiotic resistance infections are also very troubling. Politicians and medical tourism advocates in India have suggested the report is an attack on a budding industry. The Lancet is one of the oldest and most prestigious medical journals in the world.
The most common carriers of NDM-1 are gram-negative E. coli and K. pneumoniae which cause urinary and respiratory infections and can potentially transfer the gene to other infectious gram-negative bacteria. As the focus has traditionally been on development of antibiotics against gram-positive bacteria such as MRSA, it is worrisome to consider how global travel can potentially propagate resistance to a multitude of disease-causing bacteria around the world with no effective treatments on the horizon.
