The impending epidemic that no one’s talking about

There’s an epidemic coming. The gram negative bacteria that produces the NDM1 (New Delhi mettalo-beta-lactamase-1) enzyme — making it invincible to powerful antibiotics like Carbapenems — is developing a resistance to the last line of antibiotic defence.

It will develop resistance to old drugs such as Colistin and Tigacycline, which were revived to counter this threat, in a couple of years, say doctors. And the process has already started. Dr Bharat Shah, a senior nephrologist in the city, says, “There are already cases where drugs like Colistin are not proving to be as effective as earlier.”

Dr Abdul Ghafur, an infectious disease expert who was one of the first in India to raise the NDM1 alarm a couple of years back, says, “Once the bacteria become resistant, thousands in ICUs all over the country, those undergoing complex procedures like transplants, or even those infected by the relatively harmless Klebsiella or e coli, will be at huge risk.”

Dr Mark Toleman, a senior research fellow at the department of Infection, Immunity and Biochemistry at Cardiff University, was part of a team that conducted a study which found that 30% of every water sample tested in New Delhi contained bacteria carrying NDM1. In a carrier test done by the team in Rawalpindi (which has similar conditions to parts of India) they found the presence of NDM1-producing bacteria in 14% of the people and 27% of the patients. “Based on the results, we estimate that a 100 million Indians are already carrying the gene,” he said.

Carrying the bacteria doesn’t put a person at risk. But if he/she develops a medical condition that requires strong antibiotics to treat it — a complex operation or a disease — then the bacteria will adversely affects his/her health as the antibiotics will fail to take effect.

The risk of infection is highest in hospitals because of a mix of unhygienic conditions as well as the fact that the sick are generally more prone to this particular infection. “The gram negative bacteria in hospitals acquire genetic characteristics from other bacteria present there,” says Dr Abhay Chaudhary, director of Haffkine Institute.

Toleman says, “Once Colistin is gone there is little if anything that can be done. Studies in the UK have shown that combinations of different drugs can be used successfully against the bacteria, but this is really hit-or-miss. The future looks especially bleak for East Asia, and the Indian government is utterly complacent at the moment.”

There seems to be no silver lining to this cloud. A new antibiotic, which would be effective against NDM1 is eight to 10 years away from hitting the market. So, for the next six to eight years we are on our own. But even that might not work out, according to Toleman.

“There is a real concern for drug companies in the West because once a drug has been developed it is likely to be copied quickly in India and China.”

The problem in India is the lack of control on use of antibiotics. Toleman says this unrestricted use will make the new drug useless fast. “It seems unfair that companies in the West should invest heavily in antibiotic development just to have their drug copied in India and then rendered useless because the Indian government has failed to put down restrictions,” he adds.

Chaudhary estimates that only 50% of Indian hospitals have a proper antibiotic policy in place. Walk in to any medicine store and you can buy the most powerful antibiotics without a doctor’s prescription. Add to this the rampant use of antibiotics in livestock feed, and the situation in India looks grim. Ghafur says politicians are not being made aware the seriousness of the issue which is why they’re not taking required steps. “Most of our hospitals are not even equipped to detect the NDM1 carrying bacteria, countering it is a long way off. We don’t even seem to want to admit that we have a problem,” Ghafur adds.

Repeated calls and e-mails to the Indian Council for Medical Research by DNA went unanswered.

So what’s the solution? We need to take precautionary measures, says Chaudhary. “We need to have a serious antimicrobial and infection control policy at our hospitals. We must have a stringent disinfectant policy that makes sure that hospital staff scrupulously disinfect medical apparatus.”

However, in a country where most government hospitals have dogs roaming in and about and open bins with swarming flies, it remains to be seen whether a proper sanitation policy is implemented.