Insights into Editorial: Babies fall victim to antibiotic resistance
According to a study, babies, infected with superbugs in birth facilities within 72 hours of being born, are dying due to drug resistance.
The DeNIS study (Delhi Neonatal Infection) followed a group of 88,636 newborn infants for 3 years starting July 2011. The doctors tracked babies born in three of Delhi’s largest hospitals — AIIMS, Safdarjung Hospital and Maulana Azad Medical College -as they were subsequently admitted to the Intensive Care Units (ICUs). Out of over 88,000 children, 13,530 were ‘enrolled’ in the study — that is, admitted to the ICU.
What has happened?
Despite early detection and appropriate medical attention, neonates with sepsis and pneumonia (both common ailments in newborns) died. The researchers found that nearly 26% of babies with sepsis died, as multi-drug resistance made the ailment untreatable.
This is because none of the drugs worked on these babies. This was a manifestation of drug resistant bacteria in the Indian population. This also clearly shows the overuse of antibiotics in humans, agriculture and livestock.
Who is to be blamed?
According to the study, three ‘superbugs’ — Klebsiella, Acinetobacter, and E. coli — are associated with over half (53%) of the infections.
- Out of this 1,934 babies (14%) were resistant to drugs and 496 babies (26%) died due to causes attributable to drug resistance and formerly curable infections.
- Multi drug resistance was the highest with Acinetobacter in 181 cases, a staggering 82%. Resistance to Klebsiella was found in 54% and E. coli in 38%.
What is a superbug?
A superbug, also called multiresistant, is a bacterium that carries several resistance genes. These are resistant to multiple antibiotics and are able to survive even after exposure to one or more antibiotics.
What causes them to mutate like that?
Like any living organism, bacteria can mutate as they multiply. Also like any living organism, bacteria have a strong evolutionary drive to survive. So, over time, a select few will mutate in particular ways that make them resistant to antibiotics. Then, when antibiotics are introduced, only the bacteria that can resist that treatment can survive to multiply further, proliferating the line of drug-resistant bugs.
What’s the main concern now?
The discovery of antibiotics less than a century ago was a turning point in public health that has saved countless lives. Although antibiotic resistance develops naturally with normal bacterial mutation, humans are speeding it up by using antibiotics improperly. According to a research, now, 2 million people a year in the US develop antibiotic-resistant infections, and 23,000 of them die of those infections.
- Medical experts are afraid that we’re one step away from deadly, untreatable infections, since these superbugs are resistant to the last-resort antibiotics.
- Antibiotic-resistance is passed relatively easily from one bacteria to the next, since it is transmitted by way of loose genetic material that most bacteria have in common. The World Health Organization (WHO) is afraid of a post-antibiotic world, where loads of bacteria are superbugs. Already, infections like tuberculosis, gonorrhea, and pneumonia are becoming harder to treat with typical antibiotics.
Why India is more vulnerable?
Some studies have found that developing countries have bacterial rates of resistance to antibiotics that are far higher than those in developed nations, with India the global focal point.
- Bacteria spread easily in India, experts say, because half of Indians defecate outdoors, and much of the sewage generated by those who do use toilets is untreated. As a result, Indians have among the highest rates of bacterial infections in the world and collectively take more antibiotics, which are sold over the counter here, than any other nationality.
- A recent study found that Indian children living in places where people are less likely to use a toilet tend to get diarrhea and be given antibiotics more often than those in places with more toilet use.
- Also, all those drugs that create resistance to antibiotics find their way into hospital sewage, which is mostly dumped untreated into rivers, canals and pits in the surrounding community where pregnant women can become infected.
- Equally worrisome has been the rapid growth of India’s industrialized animal husbandry, where antibiotics are widespread. Most large chicken farms here use feed laced with antibiotics banned for use in animals in the United States. A New Delhi science group recently found antibiotic residues in 40% of chicken samples tested.
What has the Indian government done in this regard?
To tackle the threat faced by India from resistance to antimicrobial drugs, the Department of Biotechnology (DBT) — through the Biotechnology Industry Research Assistance Council (BIRAC) — has launched a fund. This is an India-focussed seed fund. DBT has invested an initial $1,00,000 in this fund. This fund is also expected to encourage biotechnology start-ups in the country.
Why research in this field is necessary?
India is facing increasing instances of deaths due to resistance to front line drugs. Experts say this is due to lax monitoring and profligate prescription by medical authorities that allow these drugs to be easily available. Besides, indiscriminate usage means that bugs are, overtime, able to resist these medicines.
The World Health Organisation statistics for 2014 give an estimated incidence figure of 2.2 million cases of TB for India out of a global incidence of 9 million, with instances of drug-resistant TB rapidly rising.
What Can We Do?
First step would be to limit antibiotic use. If a patient has a virus, for instance, an antibiotic won’t work, so doctors shouldn’t prescribe antibiotics even if the patient insists. And when patients do need antibiotics, it’s important to make sure they take the full course to kill off every last infection-causing germ. Otherwise the strong survive, mutate, and spread. As a society, curbing antibiotic use in healthy animals used in human food production is another important step.
According to few recent studies, nanotechnology holds the key to stopping antibiotic-resistant bacteria and the deadly infections they cause. Scientists have developed light-activated nanoparticles — each roughly 20,000 times smaller than the thickness of a single human hair and have shown in lab tests that these “quantum dots” are more than 90% effective at wiping out antibiotic-resistant germs like Salmonella, E. coli and Staphylococcus. With the emergence of this Colistin-resistant E.coli, the medical community is going to be working harder and faster to contain superbugs and develop new treatments for infections.
The global community needs to urgently address the indiscriminate use of antibiotics in an actionable manner and fast-track research on the next generation of drugs.