Latest Indian Blockbuster to hit Singapore

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Sep 15, 2010

New superbug found in two patients here in Singapore

Both cases successfully contained as experts urge health officials to track deadly bacteria

By Poon Chian Hui

A NEWLY found superbug from India that has been making news around the world infected two patients here early this year - before anyone knew what they were dealing with - but was successfully dealt with and contained.

The Ministry of Health (MOH) told The Straits Times that the patients had infections from bacteria with the New Delhi metallo-beta-lactamase-1 (NDM-1) gene identified last month.

The gene has the ability to shield bacteria from all antibiotics, turning them into drug-resistant superbugs.

It was found in the samples from the two patients last month, after hospitals went back and tested past samples.

'Following reports of NDM-1 in other countries and the availability of newer and more sensitive tests, our hospitals found two cases from the beginning of this year that were positive for NDM-1,' said an MOH spokesman.

One was a Singapore resident who had sought medical treatment in India, while the other had come to Singapore from Bangladesh for medical treatment.

They had been admitted at different times to the Singapore General Hospital. The patients were screened for drug-resistant bacteria when they showed signs of illness besides the one they had gone in for - an indication they might also be infected with a superbug.

Both were quickly isolated from other patients after bacteria in their urine samples were found to be resistant to drugs.

MOH said they were moved to single-bed rooms and had limited contact with visitors.

Health-care staff who attended to them also donned protective gear such as a gown and gloves at all times.

Both patients were discharged when subsequent urine tests showed no further growth of the bacteria, said MOH.

It is not known what other treatment they were given, but the ministry noted that strict hospital infection control measures are the key to fighting superbugs.

One measure is the retroactive testing of bacterial samples, following the discovery of a new mechanism for bacterial resistance.

Strains with unusual antibiotic resistance are stored for future study, said the MOH spokesman.

NDM-1 made the headlines after a study published on Aug 11 in The Lancet medical journal said the gene was detected in British patients in 2007, and appeared to have originated from India. So far, it has occurred mainly in two gut bacteria - Escherichia coli (E. coli) and Klebsiella pneumoniae.

The news triggered a global reaction as NDM-1 is able to resist even the most powerful class of antibiotics known as carbapenems.

Cases have now been reported in places such as the United States, France, Germany, Australia, Hong Kong and Japan. Last month, a Belgian man became the first known fatality.

On Monday, scientists at the Interscience Conference on Antimicrobial Agents and Chemotherapy urged the health authorities to track bacteria with the gene.

The conference in the United States, which ended yesterday, is the world's largest gathering of infectious disease specialists, attracting about 12,000 people.

Drug-resistant superbugs are not new and include methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa.

MRSA is a serious infection found mostly in hospital settings, while the latter usually infects the lungs.

The NDM-1 gene is a part of a bigger problem of drug resistance brought about by the abuse of antibiotics worldwide.

To fight the spread of these bugs, local hospitals have comprehensive infection control measures.

Hospital staff practise strict hand hygiene and are audited regularly.

Inpatients are also screened for existing superbugs such as MRSA.

There are also antibiotic stewardship programmes to help doctors prescribe the right type and dosage of antibiotics to minimise the rise of drug resistance.

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It’s not the superbug, it’s our own stupidity
Published: Thursday, Sep 16, 2010, 3:39 IST
Place: Mumbai | Agency: DNA




Maybe the superbug — bacteria that are super-resistant to many antibiotics — is a Western conspiracy dreamt up to hit the Indian medical tourism industry. But the superbug is for real. It is not an import. It’s hard to dispute that cases of the superbug are
underreported in India where everyone at all levels is complicit in having bred it — the doctor, the pharmacist, the patient, and the health regulators. Understanding and remedying that is what we should really be bothered about, not conspiracy theories.

Let’s be clear about the core of the problem: superbugs are emerging in a medical environment where Indians are overdosing themselves on antibiotics. Thanks to a general lack of hygiene, low public awareness about contagion, and a lackadaisical regulatory regime, doctors are prescribing antibiotics at the drop of a hat. Patients are willing to go along to get rid of ailments, and pharmacies dish out pills without proper prescriptions.

In the Indian scenario, doctors prescribe antibiotics to patients even over the telephone, with patients sometimes suggesting the remedies themselves. This is not only against medical prudence, but also an invitation to self-medication.

Besides, it’s no secret how drugs get pushed onto the consumer in the first place. Medical representatives hardsell high-cost antibiotics to doctors through freebies, and few doctors bother to ask about their efficacy. In this scenario, it is worth asking if doctors have forgotten their Hippocratic oath — where the first requirement is that they should do no harm to the patient. Doctors who are trigger-happy about prescribing antibiotics are contributing to the emergence of the superbug.

Public health is now in conflict with commercial interests (with pharma companies, chemists and doctors in cahoots). Instead of prescribing holistic measures to improve health — diet, yoga, relaxation, and build-up of immunity — there is an unspoken understanding to place the industry’s financial health above that of the public’s. This is the conspiracy we need to be concerned about, not the western one against medical tourism.
 
One was a Singapore resident who had sought medical treatment in India, while the other had come to Singapore from Bangladesh for medical treatment.

Wow, I really hope they didn't travel the same MRT with me...
 
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