Some medical tourists who went to India and Pakistan looking for cheap health procedures have come back with an unwanted souvenir: a drug-resistant strain of bacteria named New Delhi Metallo-beta-lactamase (better known as NDM-1). According to Medicinenet, NDM-1 bacteria usually cause urinary, wound and bloodstream infections. Symptoms include fever and fatigue. In terms of its health impact, NDM-1 is not much different from other bacteria in the infection-causing Enterobacteriaceae family. The reason NDM-1 has caused a stir is it is resistant to most anti-biotics.
Many NDM-1 strains are resistant to all antibiotics except for colistin. Colistin is an older antibiotic that has not been used much in recent decades, because it is somewhat more toxic than other antibiotics. A few NDM-1 strains have been sensitive to tigecycline (Tygacil), but this agent should be used cautiously in serious infections because it does not achieve high levels in the bloodstream. A few strains have also been sensitive to aztreonam, although the U.S. strains were not. Researchers have identified a new antibiotic compound that may inhibit NDM-1 containing bacterial topoisomerase function so the bacterial replication is inhibited or stopped. Unfortunately, the compound has not gone through any clinical trials and is not commercially available.
Hence, it’s best to avoid infection in the first place. Good hygiene (such as hand washing after using the bathroom and before eating) goes a long way toward protecting from NDM-1. So does properly sterilized hospital equipment. Since NDM-1 also finds safe-harbour in contaminated water, having clean drinking water is key as well.
So far fewer than 100 medical tourists have been infected. Yet even this limited number worries health officials. They fear growing numbers of medical travellers could bring all kinds of drug-resistant diseases back from the developing world. Australia is particularly concerned – its up-trend in medical tourism and proximity to Asian medical tourism destinations leave it especially vulnerable to bacteria such as NDM-1.
In this sense NDM-1 is an economic as well as health threat. Globalsurance recently noted that Thailand (a key destination for Australian medical tourists) hopes to make medical travel a USD 3.3 billion industry by 2015. The industry blog quoted Anita Medhekar, an economist at Central Queensland University, who said
internationally approved hospitals in India and Thailand match some of the best medical facilities in the world, and their staff is second to none. Many of the doctors employed at these facilities are trained in western countries and are all English speaking. In some cases, what we are seeing is high rise, state-of-the-art hospitals combining with five-star accommodation. The first few floors are for diagnosis, surgery and medical suites, and the remainder is similar to any top-end resort.
If drug-resistant bacteria become more common, medical tourists may have to ask: is luxury-style healthcare really worth picking up a superbug?