Medical tourism hastens global spread of supergerms, study finds

American, Canadian, British and Australian patients looking to save money by traveling to India for surgeries are hastening the spread of drug-resistant ‘super-bugs’ in hospitals back home, suggests a report published Wednesday in The Lancet Infectious Diseases.

Strains of E. coli and Klebsiella pneumoniae that are resistant to carbapenem antibiotics — frequently a patient’s last line of defense against multidrug-resistant hospital infections — are spreading through the United Kingdom, according to the report. Several cases have involved patients who recently returned from hospital stays in India and Pakistan, according to the report and an accompanying editorial by University of Calgary microbiologist Johann D Pitout.

The paper identified infections with the enterobacteria that produced New Delhi metallo-beta-lactamase (NDM)-1 enzymes, antibiotic-resistance promoting chemicals common in Acinetobacter and Pseudomonas aeruginosa infections. NDM-1 enterobacterial infections are widespread in India and Pakistan, the authors report.

Infections with NDM enterobacteria have been reported recently in the USA, Canada, the Netherlands and Australia — prompting a call for tighter monitoring of hospital-acquired infections in medical tourists.

“The worldwide spread of multi-resistant NDM-producing Enterobacteriaceae will have serious implications for the empirical treatment of hospital-associated and community-associated infections,” Pitout warns. “To make matters worse, there are very few antibiotics in development with activity against Gram-negative bacteria. Of particular concern is that NDM enzymes are present in E. coli; the most common cause of community-acquired urinary tract infections.”

The study was funded by the European Union, Wellcome Trust and pharmaceutical corporation Wyeth.

Further reading:

Kumarasamy KK, Toleman MA, Walsh TR, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan and the UK: a molecular, biological and epidemiological study. Lancet Infect Dis. DOI:10.1016/S1473-3099(10)70143-2.

Pitout JDD. The latest threat in the war on antimicrobial resistance. Lancet Infect Dis. DOI:10.1016/S1473-3099(10)70168-7.