Last week the British Medical Journal The Lancet reported that a new bacterium resistant to almost all antibiotics, coined New Delhi metallo-lactamase-1 or NDM-1 has emerged from India and Pakistan, and infected patients in Canada, the United States, Australia, Sweden, and a number of other countries.

Labeled “superbugs” by medical authorities, these bacteria resist strong antibiotics that are administered only when more common ones have failed. The NDM-1 gene mutation has been identified on plasmids- small fragments of DNA that easily move from one bacteria strain to another. The gene spreads primarily among bacteria that frequently cause respiratory and urinary tract diseases. The vast majority of NDM-1 infections have occurred in “medical tourists” who traveled to South Asia for elective surgeries such as face lifts, dental implants, hip replacements and even organ transplants. The Lancet researchers found that 37 Britons who had been treated in India and Pakistan carried NDM-1 bacteria when they returned to the United Kingdom. They also reported that dozens of bacteria samples with the NDM-1 gene had been discovered in two Indian cities, speculating that local hospitals probably were overusing antibiotics. Indian health authorities have been quick to retort,

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claiming that the Lancet report was seriously flawed and underwritten by foreign pharmaceutical companies who stood to gain from a global panic. “It's all hype and not as bad as it sounds,” said Karthikeyan Kumarasamy, lead author of a March report in the Journal of the Association of Physicians in India outlining the risks posed by NDM-1. “The threat of the NDM-1 is not that big as, say, H1NI (swine flu).” He added “”The conclusion that the bacteria were transmitted from India is hypothetical. Unless we analyze samples from across the globe to trace its origin, we can only speculate.” Whether or not the new drug resistant strains can be traced back exclusively to South Asia, the possibility alone should remind us that obtaining health care in other countries, does have its risks. Many of the medical facilities in India and other developing countries are first class, and staffed by well trained physicians. They are able to provide the same level of care as can be found in the United States. Nonetheless, the globalization of medical care may inadvertently permit “superbugs” such as the NDM-1 bacteria to emerge and rapidly spread across the globe.


About The Author

Frank Gillingham, M.D. serves as Chief Medical Director for HTH Worldwide. Frank has led HTH Worldwide's international business development efforts in Europe and Canada and has been a guest speaker at international business conferences and has authored a series of articles on travel medicine, including pieces on travel information available on the Internet and the role of physicians working with travel insurers. Frank is a Board-Certified Internist and Emergency Medicine Specialist. He is also a private emergency physician in Southern California and a former emergency department director and member of the UCLA emergency department staff. Frank completed residency training at Los Angeles County/USC Medical Center, received his M.D. from Albert Einstein College of Medicine and his B.A. from the University of Pennsylvania .

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