Antibiotic-resistant enterobacteria are being spread in sewage systems in India. NDM-1 producing bacteria were found in water supply and sewage seepage samples in New Delhi in a study from May 2011 in The Lancet (attached).


NDM-1 stands for New Delhi metallo-beta-lactamase. This is an enzyme that has recently been discovered in enterobacteria (such as E-coli, Klebsiella, Shigella, Proteus, Enterobacter, etc. These are mainly gram-negative bacteria which means the membranes of these bacteria are less sensitive to antibiotics to start with. What is serious about NDM-1 is that this enzyme mutation renders these bacteria insensitive to commonly available antibiotics. Cases have been detected in India, Pakistan, the UK and other locations. See attached the breakthrough article in the Lancet from 2010.


What I find somewhat alarming is that this is being dealt with almost entirely as a medical problem centering on improper use of antibiotics. And the first line solutions remain to be more sophisticated antibiotics. But these are not forthcoming and probably won't be for at least 10 years, if ever. An integrated preventative approach involving water, sanitation and hygiene experts and practitioners has still yet to be initiated. Containment of faeces and reduction of associated pathogens should be the top priority for all cities at risk. Waterborne sanitation systems were never designed to eliminate these sorts of superbacteria and now that they are even turning up in the chlorinated water supply system we can see what sort of monster this can develop into.

News this month from Hongkong indicate that mainland China is now a source of these mutated E. coli as well. www.scmp.com/news/hong-kong/article/1084...e-fourfold-hong-kong

For more reading see the additional 2 attachments.



Arno Rosemarin/SEI

Hmm, if this is already wide spread in the general population it will be very difficult to contain... however most likely improved hospital sewerage treatment might lessen the problem.

Antibiotic resistant bacteria might well turn into one of the major burdens of the 21st century, just good hygiene will probably not solve that problem as the genes for that are transferred horizontally between bacteria species. Add to that, that many potential pathogens are opportunistic, e.g. might live with you for an extended period of time, on your skin or in your guts without ever causing trouble, but "activate" once your immune system is weakened. If you are then treated with an antibiotic you are actually helping those resistant strains to multiply without competition, which is a recipe for disaster.
Good personal hygiene will help somewhat, but you always have these bacteria on your skin and in your guts, in fact removing them would make you ill.
So these resistant bacteria really have to be dealt with in a way that they never even develop, as once the resistance giving plasmids are out in the wild it's almost impossible to get rid of them again.

So how can this be done? Well these resistances develop where antibiotics are administered to patients, mostly in hospitals (but also in ambulant and self medicating patients, as well as in industrial livestock farming), and the only way to really stop this from happening (given you still treat the patients) is to have an effective mix of antibiotics to make sure one of them finishes of the bacteria that might have been become resistant to the others.

So to conclude... improved hygiene and especially treatment of hospital wastes might lessen the problem somewhat, but it really needs to be dealt with at the source! That however can only be done by strictly regulating the use of antibiotics and developing new and improved ones that are still effective.

It seems also an argumant to minimise waterborn sewage system and focus on well functioning UDDT systems.