The death of an American woman from a “nightmare bacteria” she contracted in India has shed new light onto the debate surrounding antimicrobial resistance (AMR) in the country. The American woman grabbed the headlines on this occasion. However, 58,000 Indian babies die every year from bacteria that may not be as much of a “nightmare”, but are still very deadly and present a public health crisis in the country.
A “nightmare bacteria”
The story of the American woman’s death was published earlier this month in the International Business Times. It was also carried in a number of regional news outlets. The IBT reported that the as-yet-unnamed woman was treated in a local hospital after breaking her femur during a prolonged stay in India. She then went on to develop infections in her reset femur and right hip with the “nightmare bacteria” in question. She was eventually repatriated to the U.S., where she died of septic shock.
The infection was with a strain of the klebsiella pneumoniae bacterium, which is responsible for a form of bacterial pneumonia. The contracted strain is resistant to the carbapenem class of antibiotics. Bacteria that are resistant to carbapenems are called carbapenem-resistant enterobacteriaceae (CRE). CRE are very difficult to treat. This is because carbapenems are often seen as the last line of defence against bacteria resistant to more common antibiotics.
What sets this story apart from other similar incidents is the fact that the bacteria was found to be resistant to every drug available to American doctors. This conclusion was reached after a sample of the bacteria was sent to the Centers for Disease Control and Prevention (CDC) in Georgia. The then CDC head Tom Frieden called the disease a “nightmare bacteria.”
A “health security threat” for India and the world
AMR is on the uptick the world over. It has reached “alarming levels” and become “a global health security threat”, according to the World Health Organization (WHO). AMR is of particular concern in India. According to Antimicrobial resistance in India: A review, the use of antimicrobial agents to treat prevalent infectious diseases in the country has been “inappropriate and irrational.” This has been occurring for many years. Combined with the chronic underfunding of India’s health sector, it has fostered a favourable environment for AMR and multi-drug resistant infections to spread. It may also be setting the stage for increased prevalence of CRE.
Before the story it broke about the woman’s death, the IBT called for India to “act seriously” upon a “historical” United Nations General Assembly declaration. This pledged to fight drug-resistant superbugs.
The IBT noted that genes such as New Delhi Metallo-beta-lactamese 1 (NDM-1) have already spread to the bacteria responsible for causing diseases such as cholera and dysentery. This renders treatment of the afflicted more difficult. Compounding this problem is the fact that India has one of the highest burdens of bacterial disease in the world. As such, the IBT suggests the country is “most vulnerable to the superbugs.”
“A deadly epidemic”
In December 2014, the New York Times wrote that superbugs constituted a “deadly epidemic…quietly sweeping India.” It noted that, at the time of writing, 58,000 newborns had died from superbugs in the last year. It added, “the rising toll of resistant infections could soon swamp efforts to improve India’s abysmal infant death rate.”
More than two years later, the problem does not seem to be abating. India’s healthcare system is already overburdened, unsanitary, and underfunded. It struggles with a number of crises including HIV, tuberculosis, and infectious diseases. It has been speculated that AMR will kill 10 million people globally per annum in future if the problem is not addressed. This does not bode well for India’s ill.