NDM-1 Superbug - Frequently Asked Questions
What is NDM-1?
New Delhi metallo beta lactamase-1 is the name given to an enzyme which destroys the most recently introduced class of antibiotics called carbapenems . This makes some of the bacteria turn into superbugs .
How did NDM gets its name?
Enzymes that destroy the widely used antibiotic class known as beta lactams are named by the researchers who first identify them. Some researchers name these enzymes present among the bacteria by the structure and function , or the initials of the patient , or the city where the patient came from.
Who identified NDM?
A team of researchers from Korea, UK and Sweden identified the NDM enzyme in a 59 year old Indian man who was a resident of Sweden and became ill when traveling in Ludhiana, Punjab and New Delhi. He then went back to Sweden where an Klebsiella. pneumoniae bacteria was cultured from him. in 2008. Timothy Walsh of Cardiff, UK was the senior scientist in the group who identified the enzyme that was named New Delhi matello-beta-lactamase-1. In fact, Lancet reports that NDM-1 was present in A baumannii bacteria in Germany in 2007. This patient had no contact with anyone in India. ( Volume 10 December 2010)
Is antibiotic resistance such as MRSA or NDM-1 really a problem?
Yes. Growing drug resistance makes expensive, safe and potent antibiotics ineffective. The threat is not like the plague or avian flu that cause sudden outbreaks – rather antibiotic resistance leads to a long term excessive number of deaths in patients infected with such pathogens. In others the cost of treatment may be increased. This requires further study in the case of NDM-1
What are superbugs?
Any bacteria which are hard to treat with ordinary and even powerful antibiotics are called superbugs. Some examples are MRSA (methicillin - resistant Staphylococcus aureus) and CRE – Carbepenem resistant enterobacteriacea)
How are superbugs created?
Microorganisms be it bacteria, parasite (like malaria) or TB bacilli or viruses acquire unique defenses against those agents that threaten to destroy them . Therefore under this threat they tend to select mechanisms that are favorable to their survival.
Bacteria exchange DNA through many mechanisms; one is by exchange of plasmids which are extra-chromosomal DNA that carry antibiotic resistance genes which are passed from one bacterium to another. Many superbugs exist naturally in the environment and with the overuse of antibiotics the resistant bacteria overgrow and become prominent. They can also make other bacteria superbugs by transferring the resistance plasmids.
Does the New Delhi name in the NDM-1 mean that the problem started from New Delhi and has spread globally?
No. The name just means the scientists identified the enzyme first in a patient who had travelled to New Delhi and decided to name it by that city. In fact, a paper in Lancet reports that NDM-1 was present in A baumannii bacteria in Germany in 2007. The patient had no contact with anyone in India. ( Volume 10 December 2010). Also cases in Bosnia have had no link to India. There is no evidence of NDM-1’s origin either in New Delhi or elsewhere in India
How easy is it to change the name of NDM?
Not easy, yet possible. Experts say that once a name is given it tends to stick. Yet, there are 30 beta lactamases enzymes that have alternate names. There is no formal committee which names enzymes unlike the one for naming of newly discovered bacteria. Dr. Karen Bush and Dr. George Jacoby have written articles on the naming of beta lactamase enzymes.
Was the naming of NDM-1 a conspiracy by foreign multinationals against the Indian medical tourism industry?
Absolutely not. The name was given as NDM-1 because there is a tradition of naming enzymes by the name of one of the cities where a patient has come from. In the case of NDM-1, the patient was not a resident of New Delhi but had travelled there and was assumed to have been infected there. He could have well been infected in Ludhiana where he initially became ill or in Sweden where he resided.
Why should we try to change the name of NDM-1?
The name New Delhi in the superbug NDM-1 stigmatized the city of New Delhi and the people of India. Yes, antibiotic resistance is a problem in India, but it is a global problem. The name New Delhi may not help India take antibiotic resistance problems seriously; instead it puts the experts in a defensive mode which is not helpful.
Should medical tourism stop due to NDM?
In one Lancet paper researchers say that they strongly advise against NHS patients from UK coming to India for cosmetic surgery. They do not provide any data that this causes more harm or costs more. Their extrapolations or inferences are entirely speculative.
Does the city name of New Delhi have advantages in the NDM name?
Yes, to many in government and private sector this is a wake-up call. Hopefully government and hospital authorities will work to control resistant bacteria. However we do not believe that “Name-Shame-Blame” is the most effective long term strategy to tackle this antibiotic resistance problem.
What can we do to stop the development of superbugs?
The answer is simple but implementation is difficult. And, we all have a role to play.
- Develop stronger policy and monitor the overuse of antibiotics
- Track emerging resistant pathogens and multidrug resistant pathogens that cause common infection in the community and in hospitals.
- Centralized testing using reference quality standardized laboratory techniques
- Conduct surveillance in their own hospitals to limit emergence and prevent inter -and intra -hospital spread and into community of resistant bacteria.
- Control hospital antibiotic use – a program called antibiotic stewardship
- Implement infection control measures and limit cross transmission of multidrug resistant strains
- Be educated on use and harm of antibiotic use
- Doctors should avoid overuse of antibiotics based on patient request and on prophylaxis
- Say no to needless use of antibiotics and avoid over the counter purchase and use of drugs
These simple measures would remove selection pressure and render multidrug resistance back to the non-resistant state. However it would take time and a concerted effort.
Answers provided by:
Dr. Manoj Jain MD MPH
Infectious Disease consultant in Memphis, USA and Indore, India. www.mjain.net and email@example.com
Adjunct Professor Rollins School of Public Health at Emory University, Atlanta
Dr Dilip Mathai MD PhD FRCP FCAMS FICP FIDSA
Professor of Medicine
Mentor: Infectious Diseases Training and Research Center (IDTRC)
Benjamin M Pulimood Laboratories for Infection Immunity and
ACC CMC Trust for Infectious Diseases (ACTFID)
Editor-in-Chief: Journal of Global Infectious Diseases
Christian Medical College
Vellore Tamil Nadu India 632004
Ph Off 91(0416)228 2921, 228 2804
Dr. T Jacob John MBBS PhD
Professor - Retired
Christian Medical College, Vellore
Former Head of Virology and Microbiology CMC
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Video by Dr. Manoj Jain, Infectious Disease physician in Memphis, USA and Indore, India
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Who else signed this petition?
13/Apr/2011: Jeril C Joy, Engineer, Bangalore
Let the Acronyms remain the same, instead change the full form to New Dwarf Metallobeta lactamase Superbug.
08/Apr/2011: K.Palanisamy, Programmer Analyst, Coimbatore, India
Don't name the disease after anyone, anything because we don't know the root from where it started.
07/Apr/2011: Amit Raj, Bhopal
Scientists have warned that a new superbug, called New Delhi-Metallo-1, which is resistant to antibiotics, has reached Britain and could spread worldwide as nothing is being developed to combat it.
05/Apr/2011: Sunjeet Jena, Student, Talcher, Odisha, India
I Think British Scientists Are Jealous Of Our Development And Therefore They Using Such Dirty Tricks To Make Our Country People Feel That Once Upon A Time We Were Under Their Rule And As They Left Us We Became Paralised
02/Apr/2011: praveen viadya, hubli, karnataka
As a responsible indian it is my responsibility to fight against the people who damage name of india
31/Mar/2011: rakesh yadav, student, gujarat university, Gujarat, India
Remove the name "NEW DELHI". coz we are Indians & we dont like this kind of things. We need To change their name Who Named NDM-1 Superbug as New Delhi.
30/Mar/2011: Sadeesh Kumar M.N.
Please avoid to put the lively place/thing names for superbug because it hurts the people who r living there and also it helps the bad name for the place too;better focus to destroy these kind of bugs and not to focus on the naming like that;so many researchers are good to give the naming,so discuss with them.
27/Mar/2011: Varun Sharma ,Software Engineer ,Purekharagrai,Suwansa,India
Request every Indian to join us in changing the name of Superbug Enzyme: http://ChangeSuperbugName.com
24/Mar/2011: Sarraah Gupta,Admin,Management Institute
No Indian would like such enzyme or superbug to be associated with our Capital of India. The Lead microbiologist who named NDM should be proud to put his name or his country's name.
name of NDM-1 Superbug changed and remove the name "New Delhi" out of the name of the superbug name?