August 11th, 2010
05:12 PM ET

Medical tourists bring home new superbug

Medical tourists seeking treatment in Asia are bringing home a dangerous type of bacterial infection that’s resistant to nearly all known antibiotics, according to a new report in the journal the Lancet.

Doctors identified 29 patients in the United Kingdom with the new infections. Most had traveled to India, Pakistan or Bangladesh for medical procedures, including elective cosmetic surgery. Dozens of patients from Asia also got the infections, according to the researchers, from Cardiff University.

Most of the new infections involved one of two common bacteria: E. coli or Klebsiella pneumoniae. In each case, the bacteria had acquired a gene making them resistant to all but one or two known drugs. The gene, with the faceless name of NDM-1, protects the bacteria by producing an enzyme that destroys antibiotics. It was first identified last year, although when the Cardiff researchers took a look for older examples, they found a handful of cases dating back as far as 2003.

While the bacteria are resistant even to antibiotics that are generally considered a "last resort" against resistance, they are susceptible to an older antibiotic, colistin, according to Dr. David Livermore, director of antibiotic resistance monitoring at the UK's  Health Protection Agency.  Colistin has not been widely used since the 1970s because of toxic side effects, according to Dr. Alex Kallen of the U.S. Centers for Disease Control and Prevention (CDC).

The new strains appear to be widespread in south Asian medical centers and have also been spotted in Canada, Australia, the Netherlands, Sweden and the United States. In June, the CDC flagged three cases where patients were infected with bacteria carrying the NDM-1 gene. All had undergone medical care in India.

The CDC told doctors to be alert to the possibility of resistant infections in any patients who have received medical care in Pakistan or India. The CDC also said patients found to be infected with the new strain should be isolated from other patients,  with doctors and nurses taking extra precautions – such as wearing gloves – to prevent its spread.

The new strains are mostly or completely confined to hospitals and are  a concern only for people getting medical care in those countries, Livermore told CNN.

While the number of known cases is small, the fact that the new gene is found in different kinds of bacteria is a significant worry. This versatility gives NDM-1 at least the potential to spread more quickly and more widely than if it were confined to a single bacteria strain. "That's a very concerning thing," says Kallen.

Adds Livermore, "What you're looking at here is like coastal erosion, a gradual winding down of our ability to treat infections. The worry is, as time goes by,  infections become a little harder and harder to treat. So much of modern medicine depends critically on our ability to treat infections as they arise."

The Lancet authors say the growing popularity of travel for medical care makes it unlikely that this particular genie will ever be stuffed back in the bottle. But they warn that such travel should probably be discouraged, saying the establishment of NDM-1 carrying strains around the world is a “clear and frightening” possibility.

soundoff (61 Responses)
  1. BigPharma Involved

    Lancet published the report; and according to it "European Union, Wellcome Trust, and Wyeth" funded the study. Wyeth is part of Pfizer and Wellcome Trust, based in London has historical association with Burroughs Wellcome that eventually become GlaxoSmithKline (GSK).

    There could be potentially big pharma interest in this study.


    August 11, 2010 at 18:10 | Report abuse | Reply
    • Common Misconception

      Of course there is a pharmaceutical interest in the study. Conspiracy theorizing over this is silly. If a resistant bacteria emerges, it’s going to mean that they’re most common antibiotic products are going to be devalued and used less, meaning they will need to switch emphasis to production of antibiotics the disease isn’t resistant to. They stand to lose money if this becomes a big issue. It doesn’t make them somehow evil.

      August 12, 2010 at 10:02 | Report abuse |
    • sid

      A survey of the material posted so far on internet on this subject seems to confirm your suspicion.

      August 14, 2010 at 06:06 | Report abuse |
  2. Tim

    I have to agree that this has conspiracy written all over it. It is probably aimed at medical tourism which could potentially screw the overbloated and overly expensive western medical industry. The west is already reeling in their own crp!

    Desperate times call for desparate measures I guess!!!!!!!!

    August 11, 2010 at 20:07 | Report abuse | Reply
    • Common Misconception

      Really? Spending thousands to fly to India and pay for a procedure doesn’t seem that cost effective. You have a serious misunderstanding if you think that Indian Healthcare is significantly less expensive than the United States for roughly equivalent treatment. Indian Hospitals are expensive, even without the anti-patient dumping laws we have here. The ‘tourists’ flying to India are 90% Indians with family over there, or otherwise people who can afford treatment in the US, but are going for either experimental or unapproved procedures, or elective procedures.
      We may have a bloated healthcare system in the United States, but we also have, say, significant malpractice laws, consumer protections laws, etc.

      August 12, 2010 at 10:08 | Report abuse |
    • Ed

      It is absolutely absurd to think there is a conspiracy using this to scare idiots who take ENORMOUS risks traveling to India and elsewhere to save a few dollars to have surgery, be it vain cosmetic surgery or procedures as serious as open heart surgery or orthopedic joint replacement. Who takes care of you and how much does it cost when you are home and complications arise???

      August 13, 2010 at 07:46 | Report abuse |
  3. Thozzomantis

    Oh my God it's a superbug..run! LOL!
    Now that the N1H1 thing has fizzled out I guess they're going to try a new approach at scaring people.
    I'm not worried.

    August 11, 2010 at 20:27 | Report abuse | Reply
    • soulsabr

      Just because the media blows one thing out of the water does not mean that everything that comes from the scientists of the world is junk news. Be careful you don't let media sensationalism numb you to using your brains when it comes to finding when threats are real, which the gene in the article has the potential to be, and not, H1N1 which was already in existence long before it became an "epidemic".

      August 12, 2010 at 08:10 | Report abuse |
    • Common Misconception

      You shouldn’t be, but not for the reasons you believe. H1N1 was a legitimate threat, but not in the sense that the media was portraying. The seasonal flu kills approximately 12,000 every year, and the danger of H1N1 was that it struck young, healthy people more strongly by causing the immune system to severely overreact. It was taken seriously because the people who needed vaccination the most were the ones who were usually in the lowest risk category. There were approximately 2,000 deaths during flu season last year from H1N1, and 40,000 hospitalizations. Your argument is similar to someone who has never been in a car accident claiming they don’t need a seatbelt – vaccination and prevention are safety measures for those that do. Those that die in car crashes (30,000 in 2009) are just as statistically miniscule a portion of the population as those that do not, but that doesn’t mean that they aren’t a serious threat. Don’t let media exaggeration dull you to genuine danger.

      August 12, 2010 at 09:55 | Report abuse |
    • mb

      it's H1N1 idiot

      August 12, 2010 at 13:48 | Report abuse |
  4. dee

    The article is questionable–it says physicians and nurses must 'wear gloves' when working with these patients, Since the AIDs epidemic, all hospitals in the US enforce something called 'universal body substance precautions'–all staff wear gloves all the time, when touching any patient. I've seen nurses violate this standard, but they do it at their own risk (or, in the case of 'bug' transmission, their other patients) and can be fired for not wearing gloves. Despite what other commenters think about value to 'big pharma' or reasons to stop 'medical tourism, this is real. There are also countries to which you can go for medical care (Israel for eye surgery, dental surgery, Brazil for cosmetic work,Sweden for cardiac care) which don't have these problems...I assume there are also others. Remember that almost everyone in many Asian countries has HepB, and tropical countries have parasites we don't have here which are communicable. It's not a joke/plot. People who go abroad for medical care should familiarize themselves withthe problems they might encounter and pick the safest alternative.

    August 11, 2010 at 23:08 | Report abuse | Reply
  5. shyam

    its certainly worrying .. but to say that there is now a superbug that resists all antibiotics is not equivalent to saying that we as humans are defenseless to it.
    The key is to build up our immune systems from an early age and lead healthy active lives so that we can stave off these infections naturally rather than rely on antibiotics.

    August 12, 2010 at 00:18 | Report abuse | Reply
    • Common Misconception

      It's not actually resistant to ALL antibiotics, only the most commonly used ones. BBC ran the same story but made sure to specify the difference.

      August 12, 2010 at 09:45 | Report abuse |
  6. Joan

    The Bug VS. the US Doctor Botched Surgery and Medical Bankruptcy

    Which is worst?

    August 12, 2010 at 01:07 | Report abuse | Reply
  7. Joan

    The Bug "OR" the US Doctor Botched Surgery and Medical Bankruptcy

    Which is worst?

    August 12, 2010 at 01:07 | Report abuse | Reply
  8. Hector

    Just like the SWINE FLU HOAX

    Scare patients so they in the US for $$$$'s. More $$$$ for US doctors and hospitals

    August 12, 2010 at 01:09 | Report abuse | Reply
    • Common Misconception

      Tell that to the 40,000 people hospitalized from and the 2,000 people who died from Swine Flu in the United States during Flu Season.

      August 12, 2010 at 10:09 | Report abuse |
    • jessi

      yeah... its totally a US conspiracy. that's why OTHER COUNTRIES ARE REPORTING IT.. moron.

      August 12, 2010 at 17:22 | Report abuse |
  9. Isaac

    It looks like a scare you into a corner case. This sounds like medical folks in the west are not happy with the medical tourism and wants to nip it....

    August 12, 2010 at 01:53 | Report abuse | Reply
  10. Carie Appleseed

    No Protection Against Active Tuberculosis

    A profit driven health care industry can place more emphasis on making money rather than protecting against infectious diseases. Tuberculosis is a contagious disease and is often deadly. When people with active TB cough, sneeze, speak, sing or spit, they expel infectious aerosol droplets. 40,000 droplets are released in a sneeze. Just one single bacterium can cause a new infection. TB bacteria can live in your body without making you sick. One in ten latent infections will eventually progress to an active disease. TB kills more than half of its victims if left untreated.

    Kindred Hospital in Arlington, Texas did not follow CDC guidelines. NO self-closing device was on the TB patient's door. An anteroom was not available since the patient's bathroom door was a few feet from the main hallway. Employees and visitors in the "isolation room" wore surgical masks which are not effective in preventing inhalation of droplet nuclei. As a nurse, I received a fit testing, but was not given a respirator with a proper air filter. It's estimated that the US has 25,000 new cases of TB each year. If you think you were exposed to TB disease, you should call your doctor and local health department about getting a TB skin test. Although I just committed career suicide, I can sleep well at night.

    August 12, 2010 at 03:25 | Report abuse | Reply
    • Melone

      Put it all in writing and contact OSHA.

      August 12, 2010 at 07:51 | Report abuse |
    • Common Misconception

      And the CDC as well as your state, local health departments. They'll want to know where their grant money is going.

      August 12, 2010 at 10:47 | Report abuse |
  11. Gutfeel

    Yet another attempt to revive the downward UK economy or is it the ailing health insurance sector that prompted some people to try the FUD – an effective marketing strategy know as Fear, Uncertainity, Doubt. This tactic involves creating an environment of F.U.D in order to restrain a customer from adopting a competitor product!! But I haven't seen such a creative use of this tactic ever.... Kudos to the British!(http://en.wikipedia.org/wiki/Fear,_uncertainty_and_doubt)

    Technically no such virus exists. There are no cases reported in India. Please check the link (http://epaper.hindustantimes.com/PUBLICATIONS/HT/HD/2010/08/12/index.shtml). This link is of a leading India daily that has a front page article on how this hoax bacteria is being used to create F.U.D in minds of Eurpean people who want to travel to Asian countries for Medical tourism!! Now you see why a heart surgery costs 30,000 pounds in the UK and only 5,000 in India.

    August 12, 2010 at 04:11 | Report abuse | Reply
    • Common Misconception

      There are less than 100 cases. This is a case of something being blown out of proportion by the media, and then ‘theorists’ (What I like to call armchair economists) taking anecdotal evidence as proof of a conspiracy. There are over a billion people in India, chances are any random doctor interviewed about hasn’t, nor will they ever, encounter this bug. Just like 99% of doctors will never have to deal with MRSA.
      You don’t think the Indian Healthcare System has just as much reason to lie about there NOT being a superbug as there is for the UK’s to make it up. How come none of you conspiracy theorists latch on to that?

      August 12, 2010 at 10:16 | Report abuse |
    • Common Misconception

      I apologize, I meant to type there are less than 200 cases. This disease also isn’t about people looking for heart transplants, it’s primarily brought back by people looking for ELECTIVE procedures, I.E. Plastic Surgery, which aren’t covered by UK’s current system. It may cost 30,000 pounds for a heart transplant in the UK, but the government pays it, not the individual.

      August 12, 2010 at 10:44 | Report abuse |
  12. Sukhbir SIngh Rattan

    I just have completed reading the original article in Journal "Lancet".There are lot of points ..... 1.The sample population is very small.They have identified 44 isolates with NDM-1 in chennai, 26 in Haryana, 37 in UK, and 73 in other sites in India and Pakistan. 2.Why they have not taken sample from China? 3.Why they have named the gene, NDM-1(New Delhi metallo -beta-lactamase 1) after New Delhi? 4.On scientific front, there are lot of loopholes...

    August 12, 2010 at 05:09 | Report abuse | Reply
    • Common Misconception

      I’m curious, do you have a degree in health, research or a related field? I do (two, in fact), so let’s go over your points.
      1. The sample population size is common for studies like this. The design of this study wasn’t to establish a comprehensive estimate of the scale of the marker, but to determine the existence of the antibiotic resistant strain in the UK
      2. No sample was taken from China because China is not typically not forthcoming with health data, especially if it means admitting they have a problem. The people the samples were taken from did not travel to China, either
      a. There is already a study on antibiotic research in China, if you had bothered to look a the footnotes or read the discussion
      b. Heddini A, Cars O, Qiang S, Tomson G. Antibiotic resistance in China——a major future challenge. Lancet 2009; 373: 30
      3. The researchers of this study didn’t name the agent, or originally identifying it. Again, if you had bothered to check the footnotes or read the article, you’d know this
      a. This is the article originally identifying the NDM-1, which was found by the Swedish, unless you conspiracy theorists believe that the Swedes have a hand in the US and UK healthcare system too
      b. Antimicrob Agents Chemother. 2009 Dec;53(12):5046-54. Epub 2009 Sep 21.
      4. On a scientific front, you have no idea what you are talking about.

      August 12, 2010 at 10:32 | Report abuse |
  13. b1caez02

    Why, when you have the person right in your grasp, is he or she not screened before entering the country...just like animals must be quarantined. The Native Americans must be bustin' a gut... all that crap the Europeans brought to North American sure did a number on them...KARMA!

    August 12, 2010 at 08:47 | Report abuse | Reply
    • Common Misconception

      How then, do you propose to screen everyone entering a country for everything in a timely manner?

      August 12, 2010 at 10:33 | Report abuse |
  14. bk

    Im curious why the superbug hasnt wiped out a billion people in southeast asia that cant afford penicllin ( much less a newer antibiotic). Wait for next week when the CDC tells us that Osama pooped out the multidrug resisant enterics ...

    August 12, 2010 at 09:06 | Report abuse | Reply
    • Common Misconception

      You seem to lack basic medical knowledge, or have read the article, so let me explain it to you (since your post is phrased as a question).
      1. This strain isn’t automatically deadly. There are lots of infections or bacteria a person can get that don’t kill. It doesn’t make the diminished treatment options less scary.
      2. This is a hospital based infection, meaning it’s usually transmitted from one patient to another through improper disinfecting, cleaning and PPE use. People get it because health care providers don’t switch gloves, fail to disinfect equipment properly between patients, etc.

      August 12, 2010 at 10:37 | Report abuse |
  15. Anthony

    Just wait till this resistance makes it to the VD world. The clap has become the new herpes!!

    August 12, 2010 at 09:44 | Report abuse | Reply
  16. bailoutsos

    Stephen Hawking : Earth Is Getting Too Small For Humanity -- We will not have to leave right away. This new gene will help trim the population down.

    August 12, 2010 at 12:16 | Report abuse | Reply
  17. Pam Demik

    This is alarming news. I'm going move to Madagascar they always avoid viruses well.

    August 12, 2010 at 14:01 | Report abuse | Reply
  18. Theo

    Why do we waste our time with useless antibiotics? We should be focusing our time on things like phage therapy or nanotechnology. Heck, we could just make our own virus that targets specific bacterium.


    August 12, 2010 at 18:27 | Report abuse | Reply
  19. drakshat

    indian should wake up to this and seriously look into its health care system ESPECIALLY ANTIBIOTIC PROTOCOLS

    August 13, 2010 at 01:43 | Report abuse | Reply
    • Massachusetts General Hospital

      They already have and are. They have much CLEANER and STERILE hospitals today then they did back then. They also have more sterile hospitals then do China.

      August 13, 2010 at 11:17 | Report abuse |
  20. drakshat

    western world should be more concerned about all drug resistant TB in HIV
    multi drug resistant ECOLI in debilitated patients wit UTI
    agreed this is lethal mutation of ECOLI variant
    but what about commercial utilization of ECOLI wit infected phages for production of drugs, insulin and where recombinant technology used mostly, that is another mutation waiting to happen we all know L TRYTOPHAN disaster cause of this
    the way to exaggerate this thing doesnt make sense........ now why is no one taking about the underdeveloped immunity of the swedes britist and american (though its not there fault they cant handle hepatitis A) but indians can
    this is going to happen in some part or the other of this world, to create such a scare in already HYPOCHONDRIA ppl of the west looks like a money making scheme to me......

    August 13, 2010 at 01:55 | Report abuse | Reply
    • Massachusetts General Hospital

      HIV is a Virus not a bacteria, and they was never a drug that would eliminate HIV. Get your facts right, then post at th site. Jeez.

      August 13, 2010 at 11:13 | Report abuse |
  21. rv

    Guys, Every summer the pharma pimps create a new bug give it a name and make millions of dollars in fake vaccines. Lets get back to our work. When we popped out of our mother, we got a death penalty. Next summer we will have a new bug BGV (British Gay Virus).

    August 13, 2010 at 02:22 | Report abuse | Reply
  22. Earl Yerby

    There are many ways hospitals and healthcare facilities are improving on disease occurance and spreading of existing bacteria. More and more effective ways of controlling resistant strains are emerging, such as http://www.healthguarduvc.com

    August 13, 2010 at 09:15 | Report abuse | Reply
  23. Massachusetts General Hospital

    1. Where is your cource that this NDM-1 originates from South East Asia? – None. If you do, did you find those proofs when you had your patients in UK? Try going to India and find the proof, a legiminate that is viewable to everyone. Then come back and yell at us.

    2. UK is have a loss in Plastic Surgery companies, in terms on money. It is probably that when the patients got sick, the doctors gave the patients the bacteria. Or they are making up this proof and are really smart from the press finding out.

    3. The research was done in Cardiff Universifty, a university in UK. Explains it. The doctrate companies, who are facing a loss in plastic surgeies department, probably paid this university to make this fake research. Do you have any other source, OUTSIDE OF UK, perferbably in US, that shows the legiminate proof that it does originate from India, and from cosmetic surgeries? Find it, and show it to us, then we will belive.

    4. Why only cosmetic surgeires? Why not heart, liver, kindeys, bladder surgires? Why Only ONE particular surgeries, while other surgeris are also cheap. Yup, this shows that it is that the companies are facing a loss in the plastic surgeries department.

    Answer those questions, and we will belive you.

    August 13, 2010 at 11:11 | Report abuse | Reply
  24. drakshat

    "Massachusetts General Hospital

    HIV is a Virus not a bacteria, and they was never a drug that would eliminate HIV. Get your facts right, then post at th site. Jeez."
    wow!! i dint know americans were little behind on short forms like TUBERCULOSIS (TB) u know the one also called Mycobacterium tuberculosis (MTB) in human immunodeficiency virus(HIV)........ u know the disease that was once out of western world and now being brought back due to HIV virus...... wow now i can have my JEEZ MOMENT...... JEEZ ............. and nothing for the rest of the stuff i wrote??......... ya ouch!!! and ya sorry i was little retard on MDR TB when we have to be talking about XDR TB......... 🙂

    August 14, 2010 at 09:27 | Report abuse | Reply
    • drakshat

      and yes by TB in HIV i meant PEOPLE who got TB after being infected by HIV

      August 14, 2010 at 09:48 | Report abuse |
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    August 14, 2010 at 10:02 | Report abuse | Reply
  26. Acmed Shams

    May we never forget how brutal and dictatorial the Taliban are and why US forces are so needed there
    Please watch this. Seriously.

    August 19, 2010 at 00:32 | Report abuse | Reply
  27. Todd Madden

    Your posting "Really? Spending thousands to fly to India and pay for a procedure doesn’t seem that cost effective.........." is so far off base its absurd. Costs in India are about 80-90% less than in the US for joint replacement and cardiac procedures. Check your sources. Go to http://www.companionglobalhealthcare.com/patients/comparecosts.aspx.

    Also, note how none of the hospitals were named as the source of this bacteria. Seems questionable to me. Further research indicated it was not from the major private hospitals (Apollo or Fortis).

    August 23, 2010 at 09:35 | Report abuse | Reply
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