Poor sanitation lets superbug thrive in India

The scientists of the superbug NDM-1 (New Delhi metallobeta-lactamase) theory said India is at a higher risk of NDM-1 infections because of its poor sanitation conditions.

Quoting a UN report which said that 650 million people in India do not have adequate sanitation, and the sewage treatment system in Delhi struggles to cater for 50 % of the population, the scientists said that poor sanitation conditions give the superbug conducive environment to spread its tentacles.

The only way to restrict it would be to implement a strong antibiotic policy and improve sanitation, scientists said.

NDM-1-positive bacteria, mostly with direct links to India or Pakistan, were reported in Australia, Austria, Canada, Belgium, France, Germany, Hong Kong, Japan, the Netherlands, Norway, Oman, Sweden, Singapore, Taiwan, the UK, and the USA. On Thursday fresh cases of this superbug were also reported from China and Israel.

Brushing aside theories that NDM-1 should be treated like any other drug-resistance strain, the scientists asserted that the superbug was a far more serious threat than others and India was vulnerable because of its “poor sanitation and heavy and unregulated antibiotic use”.

Many NDM-1 bugs in the gut can spread to a wider population through the faecal-oral route, they warned.

“This paradox [state of the art surgery vs poor sanitation] presents an immense challenge and should be of great concern to the WHO and to the Indian health authorities,” the authors said in the latest issue of British medical journal The Lancet Infectious Diseases.

The scientists were responding to letters on their original article, many of which were written by angry Indian doctors. Some of the researchers also said that the NDM-1 bacteria was extremely promiscuous as it has not only spread rapidly in the last 3 years but has also crossed the “genus barrier”, which makes its management more tough for doctors in the future.

The researchers said NDM-1 was more dangerous than MRSA (another superbug called methicillin resistant staphylococcus aureus). While MRSA is a “gram positive bacteria” for which more drug options are available, NDM-1 is a “gram negative” bacteria with limited treatment options.

Gram negative bacteria are difficult to treat as they have an extra membrane around their cell walls that protects them against antibiotics. Bacteria with NDM-1 herald the end of treatment with drugs like beta-lactams, fluoroquinolones and aminoglycosides — the main antibiotics for gram negative bacteria.