A ‘nightmare’ superbug claimed the life of an elderly woman from Reno, Nevada, in the US late last year. The woman was suspected to have contracted the infection during her visit to India. It is an alarming story, more for Indians than for the Americans as post-mortem tests on the microbe have provided disturbing evidence.
The woman, in her seventies, was infected by carbapenem-resistant Enterobacteriaceae (CRE), more specifically Klebsiella pneumoniae. CREs are gram-negative bacteria capable of rendering even the last resort antibiotic, carbapenem, completely ineffective. Infections caused by them are mostly fatal.
In the case of this woman, the analysis of the microbe has shown that it produced New Delhi metallo-beta-lactamase (NDM-1), an enzyme that directly breaks down carbapenems. And NDM-1 itself was identified in 2009 after a Swedish woman had picked up an infection following a hospital stay in India.
Although similar cases have already been reported in the US in the past, the case of the woman from Nevada became more noticeable because the bacteria that infected her has shown resistance to a larger array of antibiotics — 26 of them according to reports of US Centres for Disease Control and Prevention.
That the woman had been hospitalised in India a few times and developed a sepsis after suffering a fracture of her thigh bone makes a strong case for it to have been a nosocomial infection, that is, one which happened during her stay at the hospital.
Drug resistance is caused by the improper administration and use of pharmaceuticals. In India, sufferers from various infections do not follow the physicians’ advice diligently. Many discontinue the prescribed course of medicines as soon as they feel slightly relieved of symptoms and discomfort.
Price of drugs has been a chief reason behind such neglect. There have also been cases of physicians prescribing spectrum drugs to people even for common infections. The situation has, at its roots, a highly imbalanced society.
The country today is witnessing pyramidical growth where beneficiaries of development are few. Many a household in the country is run with single incomes. The sole breadwinners need to toil without rest or respite to keep the home fires burning.
Health takes a back seat in such households and diseases are considered causes for wasteful expenses. There is also the problem of fake drugs flooding the market. While India is the third biggest pharmaceuticals producer in the world in terms of volume, about 20 per cent of the drugs produced in the country are fake.
Drugs of poor quality, too, help make a variety of microbes resistant to them. And doctors — in many cases fearful of failure on their part to make accurate diagnoses — prescribe spectrum drugs as a gamble. If one part of the combination misses the bug, the other might get it and cure the infection. While it helps the patient recover, the drugs also help certain microbes develop resistance to the drugs administered.
Multi-drug-resistant microbes such as Klebsiella pneumoniae are part of a growing global health threat. The World Health Organization (WHO) has termed K. pneumoniae as “an urgent threat to human health”.
India must pay heed to this warning. There is a need to set right the many imbalances to foster healthy generations. There is no magic wand or a cure-all to set the situation right in the blink of an eye.
But more concerted efforts are required across the board: At the hospital level there is a need for proper, diligent administration of drugs; there is a need to create greater awareness among people against improper use of drugs and, above all, pharmaceutical companies must be encouraged to produce cheaper but quality drugs to meet the needs of the poor.
Better mechanisms need to be developed for the responsible disposal of excess production and of hospital wastes and most important, a better social security net needs to be deployed to relieve the needy of the compulsions of livelihood that deprive them of necessary rest.
Health of the country cannot be trifled with. As of now, focus on the health sector has been minimal in the Union Budgets of the past decade. We have to wait and see if the upcoming 2017-18 Budget holds any new promises in the field of healthcare.
