A lot of sensation has been created by a report in Lancet, online published on August 11, 2010, by Karthikeyan K Kumaraswamy et al about emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK. It has an interpretation which links its spread possibly from India. This publication reports the presence of a plasmid associated with drug resistance to several antibiotics including third generation cephalosporins in gram-negative bacteria.
While the title and the contents broadly describe the antibiotics resistance profile of gram negative bacteria and its mechanism due to New Delhi metallo-b lactamase (NDM-1) gene in the plasmid, the conclusions are loaded with inference that these resistance genes/organism possibly originated in India and it may not be safe for the UK patients to opt for surgery in India. Concluding sentence presents a frightening picture which is not supported by any scientific data.
Over the decades, it is known that plasmids are present in gram negative bacteria, they can be transmitted among bacteria and they may also encode for resistance for many drugs. However, this is a phenomenon which occurs in nature - in the environment, may be intestines of humans and animals universally. Their might be billions of such happenings at any moment.
It should have been highlighted that getting infection by such drug resistant bacteria is a matter of chance, is a global phenomenon and is preventable by sound infection prevention strategies which are followed in any good hospital. A national resistance alert was issued in July 2009 in UK hospitals, and similar alert has been sounded now also. It may be noted that similar plasmids have been reported from Israel, USA, Greece and even in this report from environment of Scotland. While such organisms may be circulating more commonly in the world due to international travel but to link this with the safety of surgery hospitals in India and citing isolated examples to show that due to presence of such organism in Indian environment, India is not a safe place to visit is wrong.
It also needs to be highlighted that several of the authors have declared conflict of interest in the publication. The study was funded by European Union & 2 pharmaceutical company namely Wellcome Trust & Wyeth who produce antibiotics for treatment of such cases. DGHS in consultation with Secretary DHR & DGICMR strongly refute the naming of this enzyme as New Delhi metallo beta lactamase & also refute that hospitals in India are not safe for treatment including medical tourism.