http://timesofindia.indiatimes.com/indi ... 300762.cms
A discussion and refutation follows
General examination
Bullshit , it was named as such because the enzyme was first sequenced from a novel Klebsiella strain that was traced to New Delhi, the paper abstract and the link to the paper both follow.
A Swedish patient of Indian origin traveled to New Delhi, India, and acquired a urinary tract infection caused by a carbapenem-resistant Klebsiella pneumoniae strain that typed to the sequence type 14 complex. The isolate, Klebsiella pneumoniae 05-506, was shown to possess a metallo-β-lactamase (MBL) but was negative for previously known MBL genes. Gene libraries and amplification of class 1 integrons revealed three resistance-conferring regions; the first contained blaCMY-4 flanked by ISEcP1 and blc. The second region of 4.8 kb contained a complex class 1 integron with the gene cassettes arr-2, a new erythromycin esterase gene; ereC; aadA1; and cmlA7. An intact ISCR1 element was shown to be downstream from the qac/sul genes. The third region consisted of a new MBL gene, designated blaNDM-1, flanked on one side by K. pneumoniae DNA and a truncated IS26 element on its other side. The last two regions lie adjacent to one another, and all three regions are found on a 180-kb region that is easily transferable to recipient strains and that confers resistance to all antibiotics except fluoroquinolones and colistin. NDM-1 shares very little identity with other MBLs, with the most similar MBLs being VIM-1/VIM-2, with which it has only 32.4% identity. As well as possessing unique residues near the active site, NDM-1 also has an additional insert between positions 162 and 166 not present in other MBLs. NDM-1 has a molecular mass of 28 kDa, is monomeric, and can hydrolyze all β-lactams except aztreonam. Compared to VIM-2, NDM-1 displays tighter binding to most cephalosporins, in particular, cefuroxime, cefotaxime, and cephalothin (cefalotin), and also to the penicillins. NDM-1 does not bind to the carbapenems as tightly as IMP-1 or VIM-2 and turns over the carbapenems at a rate similar to that of VIM-2. In addition to K. pneumoniae 05-506, blaNDM-1 was found on a 140-kb plasmid in an Escherichia coli strain isolated from the patient's feces, inferring the possibility of in vivo conjugation. The broad resistance carried on these plasmids is a further worrying development for India, which already has high levels of antibiotic resistance.
They talk about the Lancet paper and try an argumentum ad hominem, but they somehow forgot to do an elementary literature review from the past? The paper above precedes the Lancet paper by nearly 11 months.
The fact that they're coming with anything but scientific rebuttals against the Lancet paper is deserving of a massive facepalm, I haven't read the Lancet paper yet (no access) , but I do have access to the summary, and this is what it reads...
Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study
Karthikeyan K Kumarasamy MPhil a, Mark A Toleman PhD b, Prof Timothy R Walsh PhD b Corresponding AuthorEmail Address, Jay Bagaria MD c, Fafhana Butt MD d, Ravikumar Balakrishnan MD c, Uma Chaudhary MD e, Michel Doumith PhD c, Christian G Giske MD f, Seema Irfan MD g, Padma Krishnan PhD a, Anil V Kumar MD h, Sunil Maharjan MD c, Shazad Mushtaq MD c, Tabassum Noorie MD c, David L Paterson MD i, Andrew Pearson PhD c, Claire Perry PhD c, Rachel Pike PhD c, Bhargavi Rao MD c, Ujjwayini Ray MD j, Jayanta B Sarma MD k, Madhu Sharma MD e, Elizabeth Sheridan PhD c, Mandayam A Thirunarayan MD l, Jane Turton PhD c, Supriya Upadhyay PhD m, Marina Warner PhD c, William Welfare PhD c, David M Livermore PhD c, Neil Woodford PhD c
Summary
Background
Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK.
Methods
Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene blaNDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan.
Findings
We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries.
Interpretation
The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.
Funding
European Union, Wellcome Trust, and Wyeth.
The nomenclature of the protein was not made by the authors of this Lancet paper, and the sample was first isolated in a patient who contracted an infection in New Delhi, and hence was named on that basis, how does that suggest anything about the origin of the bug in India? and I see nothing about the origins of the bug itself being mentioned in the Lancet summary, at least, so what are the eejits spouting off about?
Now for the dissection :thumbup:
Yada yada bullcrap, the enzyme was first documented in the literature in 2009, dimwits, and the reason why it was named as such has already been explained on the basis of the paper I already cited.NEW DELHI: India today described as "totally irrational" a report that a new superbug resistant to antibiotics originated from the country and strongly protested a British alert in this regard and the new enzyme being named as 'New Delhi Metallo- 1'.
If the bug is most prevalent here, as the data from the Lancet paper seems to suggest, there is more chance of being exposed to it, in the same way as living in flu-hit areas can increase the chances of being infected yourself, so indeed the risks would be more, this is an asinine canard being put forth here by Mr.Katoch."When you link it to our antibiotics policy, say it is India specific, say it is dangerous to get operated in India then you will get more infections, that is totally irrational," Director General Indian Council for Medical Research V M Katoch said.
Oh yes, they did :picard: , blind assertions are not refutations in any logically consistent universe, and how can one "refute" nomenclature being based on a criterion which is totally different from what they're alluding to.The Director General of Health Services R K Srivastava along with Katoch "strongly refuted the naming of the enzyme as New Delhi metallo beta lactamase and also refuted that hospitals in India are not safe for treatment including medical tourism".
So, the Lancet paper's findings are all disputed by a "hard hitting statement"?The health ministry came out with a hard-hitting statement after a paper published in scientific journal 'Lancet', said the new superbug, which is said to be resistant even to most powerful antibiotics, has entered UK hospitals and is travelling with patients who had gone to countries like India and Pakistan for surgical treatments
I never saw any loaded inferences in the summary, which I've posted for all to see, so this is more baseless strawmanning and chest beating stemming from it, and what part of possibly does the guy who wrote the statement not understand?The ministry said the conclusions of the article are loaded with inference that these resistance genes or organisms possibly originated in India and it may not be safe for the patients in the United Kingdom to opt for surgery in India.
And the refutation is motivated by India's medical tourism market? See, I can slander and make accusations too? Morons! and since when science become a matter of democracy and political examination? Who the naughty gave these morons the idea that they could dispute science with slander? Or is it just a case of projection?It said the contents of the article present a "frightening picture" which is not supported by any scientific data.
The issue was also raised in the Rajya Sabha by members who suspected the hands of multi-national pharmaceutical companies and hospital chains behind the scientists' claim.
Did someone say vested interests?Indian medical tourism industry is making rapid progress providing treatment and surgeries to global patients at significantly lower costs. The sector has been estimated at Rs 1,200 crore.
Since when did the Indian MoH become official peer-reviewer for the Lancet? If the ministry is so inclined it can get such a "point" published in the Lancet as well by producing research of their own, not just statements. The same (chance, global phenomenon, prevention) is true for many diseases too, no shit, Sherlock, and the Lancet paper suggests that global surveillance is indeed required, so there.The statement further said "it should have been highlighted that getting infection by such drug resistant bacteria is a matter of chance, is a global phenomenon and is preventable by sound infection prevention strategies which are followed in any good hospital".
How does the presence of the plasmid elsewhere automatically make Indian hospitals safe? The thing is a problem wherever it is prevalent, and at the moment the data is indicative of high prevalence here, the fact that it may pose unknown threats elsewhere doesn't mean precautions shouldn't be taken where prevalence is definitely noted, again the person who wrote the statement needs to have some sense knocked into him.It may be noted that similar plasmids have been reported from Israel, USA, Greece and even in this report from environment of Scotland, it said.
"While such organisms may be circulating more commonly in the world due to international travel, but to link this with the safety of surgery in hospitals in India and citing isolated examples to show that due to presence of such organism in Indian environment, India is not a safe place to visit is wrong," the statement said.
Because extant data is indicative of higher prevalence here? The alert is not against India, it is against those bacteria Mr.Katoch, since when did bacteria begin to have nationalistic allegiances? And if they're known to be present somewhere they definitely can pose a real threat.Katoch said, "you can't say which is the source. It is a naturally occurring bacteria. So why has the alert been issued only against India".
There is also an observed trend (travel to high prevalence regions) that mandates precaution in the short term at least, while further corroborative studies are carried out, this is a matter of public health and not nationalistic jingoism, wake the fucking hell up.
Argumentum ad hominem, good old load of fail, where does the paper/the summary at least assert that the bug originated in India?The ministry claimed that several of the authors of the article have declared conflict of interest in the publication. The study was funded by European Union and two pharmaceutical companies namely Wellcome Trust and Wyeth who produce antibiotics for treatment of such cases. It was written by Karthikeyan K Kumaraswamy along with others.
Professor N K Ganguly, former director ICMR and a leading biotechnologist, said it was wrong to state that the superbug originated from India.
"Already such bugs, which make bacteria resistant to nearly all antibiotics, have been reported in various European countries in the past. Already one or two countries are conducting research in this regard," he said.
Irrelevant wibble.Dr Sarman Singh, professor of laboratory medicine, AIIMS said, "We have come across cases where the bacteria is resistant to multiple drugs and antibiotics. But then it is dealt with various other drugs and we have achieved success in certain cases too. Already research is being conducted in this regard by ICMR. Alleging that it originated in India is very wrong."
Now I don't now who to cuss at more, the idiotic media or the morons responsible for these canards.
