Antibiotic-Resistant Bacteria Moving From South Asia to U.S.

By DONALD G. McNEIL Jr.

Published: August 11, 2010

A dangerous new mutation that makes some bacteria resistant to almost all antibiotics has become increasingly common in India and Pakistan and is being found in patients in Britain and the United States who got medical care in those countries, according to new studies.

Experts in antibiotic resistance called the gene mutation, named NDM-1, “worrying” and “ominous,” and they said they feared it would spread globally.

But they also put it in perspective: there are numerous strains of antibiotic-resistant germs, and although they have killed many patients in hospitals and nursing homes, none have yet lived up to the “superbug” and “flesh-eating bacteria” hyperbole that greets the discovery of each new one.

“They’re all bad,” said Dr. Martin J. Blaser, chairman of medicine at New York UniversityLangone Medical Center. “Is NDM-1 more worrisome than MRSA? It’s too early to judge.”

(MRSA, or methicillin-resistant staphylococcus aureus, is a hard-to-treat bacterium that used to cause problems only in hospitals but is now found in gyms, prisons and nurseries, and is occasionally picked up by healthy people through cuts and scrapes.)

Bacteria with the NDM-1 gene are resistant even to the antibiotics called carbapenems, used as a last resort when common antibiotics have failed. The mutation has been found in E. coli and in Klebsiella pneumoniae, a frequent culprit in respiratory and urinary infections.

“I would not like to be working at a hospital where this was introduced,” said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University. “It could take months before you got rid of it, and treating individual patients with it could be very difficult.”

A study tracking the spread of the mutation from India and Pakistan to Britain was published online on Tuesday in the journal Lancet.

In June, the Centers for Disease Control and Prevention noted the first three cases of NDM-1 resistance in this country and advised doctors to watch for it in patients who had received medical care in South Asia. The initials stand for New Delhi metallo-beta-lactamase.

“Medical tourism” to India for many surgeries — cosmetic, dental and even organ transplants — is becoming more common as experienced surgeons and first-class hospitals offer care at a fraction of Western prices. Tourists and people visiting family are also sometimes hospitalized. The Lancet researchers found dozens of samples of bacteria with the NDM-1 resistance gene in two Indian cities they surveyed, which they said “suggests a serious problem.”

Also worrying was that the gene was found on plasmids — bits of mobile DNA that can jump easily from one bacteria strain to another. And it is found in gram-negative bacteria, for which not many new antibiotics are being developed. (MRSA, by contrast, is a gram-positive bacteria, and there are more drug candidates in the works.)

Dr. Alexander J. Kallen, an expert in antibiotic resistance at the C.D.C., called it “one of a number of very serious bugs we’re tracking.”

But he noted that a decade ago, New York City hospitals were the epicenter of infections with other bacteria resistant to carbapenem antibiotics. Those bacteria, which had a different mutation, were troubling, but did not explode into a public health emergency.

Drug-resistant bacteria like those with the NDM-1 mutation are usually a bigger threat in hospitals, where many patients are on broad-spectrum antibiotics that wipe out the normal bacteria that can hold antibiotic-resistant ones in check.

Also, hospital patients generally have weaker immune systems and more wounds to infect, and are examined with more scopes and catheters that can let bacteria in.

Prem Chand, A Pakistani

http://pakistaniat.com/2010/08/01/prem-chand-coffin-kafir/

Amongst the 152 who died in last Wednesday’s tragic crash of Air Blue flight were six members of the Youth Parliament. All death in this tragedy were sad. The death of these talented youth with aspirations of building a better Pakistan was no exception. Maybe it was tragedy compounded. But the story of one of them is sadder even than the others – and because of what happened to him after he died!

 

This is the story of Prem Chand, a bright young social worker from Sanghar (Sindh), one of the members of Youth Parliament, and one of those who died on the ill-fated AirBlue flight 202. His death – like the death of everyone on that flight – was a matter of national tragedy; the treatment of his dead body a matter of national disgrace.

According to news reports in The News and The Express Tribune young Prem Chand’s coffin was marked “Kafir” – a word that literally means ‘infidel’ or ‘non-believer’ but is mostly used as a serious slur in Pakistan. Literally labeling someone’s coffin as “Kafir” and not even giving them the respect to list their religion by its proper name, is a shameful and disgusting way to disrespect the last remains of anyone. All the more so the last remains of a patriotic Pakistani who was on that plane solely to represent Pakistan and to seek to be a better Pakistani – he was on his way to the ‘session’ of the Youth Parliament!

According to The News:

The members of Youth parliament [on the day following the crash] protested against the marking of the coffin of one of their colleague Prem Chand as ‘Kafir.’ “It was shocking. He could have been marked as Hindu or non-Muslim, but using the word ‘Kafir’ is the worst example of intolerance,” said MYP Muneeb Afzal.

The Express Tribune writes:

Ehsan Naveed Irfan is a member of the youth parliament and he is the one who identified Prem Chand’s body. He told me that his coffin was marked as “Kafir” first with black and then outlined with red to make it more prominent. He told me that he and his friends removed it with a marker and wrote “We love you – from the youth parliament” instead.

A friend of Prem Chand made this comment on Syed Ali Abbas Zaidi’s blog:

I am Muneeb Afzal, a Member of Youth parliament of Pakistan and a Colleague and Friend of Late Prem Chand. An extremely hard-working person he was a symbol of tolerance. My last communication with him was on night before the Air Crash, he gave his greetings to me on occasion of 15th of Shabaan.

At PIMS fortunately another friend of ours was there when Prem’s Cousin Nanik Das came to search for his body, he quickly hid the tag ‘kafir’ by putting marker lines on it, so that Prem’s family which is already suffering from great grief does not have to bear more hurt. Although later at a memorial session where media was present I criticized the inhumanity and intolerance of those who did this shameful act. I felt this was my duty to my late friend Prem Chand that I make it clear to the world that we condemn this act of intolerance and narrow mindedness. But a lot of my other colleagues have since objected to my speaking out, believing that my saying this and this news spreading in media would add to hurt of Prem’s family, and in a way they are right too. I would like you all to also keep this in mind as well…

This was probably not an official act or some state sponsored standard procedure. It is much more likely that this was an act of some sick minded individual. But it is still important for the authorities to investigate and punish those responsible, and set an example for future. Intolerance must not be tolerated. To tolerate it, or justify it, is to accept it. The authorities need to take responsibility for this incident and why it happened at all; no matter who did it. After all, it is the state of Pakistan – and we as a society – which creates the conditions in which the persecution of minorities thrives at various levels, directly and indirectly; and that is what gives individuals license to go even further – including such shameful acts.

Author’s Note: My deepest apologies to friends and family members of Prem Chand and my fellow Pakistanis from others faiths (Pakistani Hindus in particular), specially those who may not have heard of this yet and for whom this incident will no doubt be deeply painful. But we must raise our voice and condemn such acts. The one lesson that Pakistan’s history teaches us is that discrimination and intolerance must never be tolerated.