Is a killer bug really lurking around in the corners of Delhi, awaiting an opportunity to attack our bodies? We get to the bottom of the superbug mystery.

All the hue and cry about Delhi's 'superbug' NDM- 1 may have died down, but many of us are still mystified and confused about whether the threat posed by this is for real. If there really is a killer bug out there, then what we can do to protect ourselves and our families from it? Here is the lowdown on this superbug and the superbug phenomenon in general, that should help you understand the scenario better.

In the past two decades, various "superbugs" or antibiotic resistant organisms that seriously threaten health and longevity have emerged.

"Such drug-resistant microbes are a global phenomenon, not specific to any country," says Dr Chand Wattal, head, clinical microbiology, Sir Ganga Ram Hospital. Worried about their potential to create disaster, medical scientists have been searching for ways to ward off these biologic invaders. While severe acute respiratory syndrome (SARS) was the superbug public health headlinegrabber some years ago, public health experts point out those other, more insidious threats - particularly those from antibiotic-resistant bacteria - continue to lurk below the septic layers of medicine.

Ironically scientists have dealt with the Hantavirus, the West Nile virus and mad cow disease well enough but no one has found a solution for the antimicrobial resistance that has been around for over 60 years. Bacteria are adaptable organisms that are still many steps ahead of science.

Not a Delhi phenomenon
The "superbug" that has been named the New Delhi metallobeta- lactamase or NDM- 1, is a new gene that allows any bacteria to become a superbug, or antibiotic resistant organism. This gene is transferable across bacteria and can make common infections lethal. People with reduced immunity are at the highest risk of succumbing to these. "Patients who are getting treated in an ICU for a chronic health problem are at the highest risk for acquiring such drugresistant infections. Not everybody who walks into a hospital can acquire the infection," clarifies Dr Wattal.

Though this gene may be found in any part of the world, in India the NDM- 1 gene is the major cause of antibiotic resistance in two bacterial species- E. coli and Klebsiella. In other countries genes are different and are named differently like VIM- 1 (for "Verona integron- encoded metallo-a-lactamase" first isolated in Verona, Italy,) SPM- 1 (for "Sao Paulo metallo-a- lactamase"), GIM- 1 (for "German imipenemase") SIM 1 (for Seoul imipenemase) and so on. Superbugs may not be an immediate threat to those carrying them, but can become dangerous to these very people after an operation when their immunity is low. Carriers can also infect other people.

Drug resistance to blame
Antibiotic resistance is one of the greatest threats to human health, says the World Health Organisation. Despite the alarm over antibiotic resistant bacteria being sounded in the past, the reality is that physicians continue to prescribe antibiotics inappropriately and people are careless about the way they take these. In recent years, bacteria or superbugs have adapted to resist multiple antibiotics, including the ' last- line' drugs, leaving no scope for complacency about the threat posed by antibiotic- resistant bacteria.

We're already seeing infections that fail to respond to the first or even second antibiotic prescribed. If we continue on this course, we're going to find ourselves back in the Dark Ages, when serious infections had no cure. The widespread misuse of antibiotics in the following ways fuels the development of resistance.

* Unnecessary prescriptions: Recommending antibiotics indiscriminately for every illness, provides the opportunity for benign bacteria to acquire resistance, that can be later passed on to pathogens. Treating infections with antibiotics without identifying the causative agent and prescribing them for viral infections that don't respond to them, are the most common ways in which antibiotics are misused, according to microbiologist Dr A K Prasad. Knowing whether or not an antibiotic is likely to be effective is crucial before embarking on a prescription."Antibiotics are prescribed most often for diarrhoeal diseases and acute respiratory infections, which don't require this treatment," says Dr TD Chugh, senior consultant, microbiology, BL Kapur Memorial Hospital.
* Incomplete course: Unfinished antibiotic prescriptions leave some bacteria alive and expose them to sub- inhibitory concentrations of antibiotics for a prolonged period. TB treatment provides an example of how antibiotic resistant strains of the TB bacterium have developed. Being several months and even years long, many abandon the treatment mid- way, fuelling the development of resistance: 5 percent of strains now observed are completely resistant to all known treatments and hence incurable.
* Adding them to animal feed: Putting antibiotics in animal feed can accelerate the development of drug resistance. Delivering antibiotics to livestock in animal feed is similar to giving people antibiotics all their life even when they are healthy. Many food borne pathogens live in a symbiotic relationship with cows and chickens. They can acquire resistant genes, infect humans, cause food poisoning from consumption of beef or chicken and can transfer those resistance genes to other bacteria.
* The antibiotic Catch-22: Despite the several deadly superbugs on doctors' radar screens, the number of new antibiotics in the market to combat them is nearly zero. This is because of the huge expense involved in developing new drugs, for which there is limited possibility of recovering revenue.


It's an antibiotic Catch-22: Doctors tend to limit prescriptions of new drugs for all but the direst infections to delay the emergence of resistant strains. So what's good for public health is a real disincentive for antibiotic development.

What needs to be done:
Educating healthcare workers and the public in the appropriate use of antibiotics; introducing or enforcing legislation related to stopping the sales of antibiotics without prescription; and strict adherence to infection prevention and control measures, including the use of handwashing measures, particularly in healthcare facilities.

SUPERBUG IQ

Avoid contracting a superbug: If a doctor prescribes an antibiotic, do ask questions about the prescription. In addition, get a lab test done to determine what kind of infection you have, and which antibiotic is likely to be most effective for this.

Avoid self medication: Self- medication and repeating the same prescription can lead to the development of resistance. So take a doctor's advice instead.

Keep washing: Scrubbing with soap and water is the best way to keep germs and super- bugs at bay. Do it before eating, after using the toilet and handling animals, and before preparing food.

Carry a sanitising gel: Using a gel with at least 60 percent alcohol between hand washings reduces the spread of disease- causing bacteria and viruses.

Stay home when sick: Avoid public places (even hospitals) when you are ill as the danger of picking up another infection is high when your immunity is low. Stay away from others who have colds, coughs or other infections too.