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March 30, 2016 at 08:23 AM
(Bloomberg) — The antibiotic colistin was the last resort for saving babies at the King Edward Memorial Hospital in Pune, India. That defense was breached last year.
In early 2015, a pediatrician at the hospital for the first time encountered two cases in which newborns had bloodstream infections caused by bacteria resistant to the critically important medicine. One of the babies died; the other survived.
“That is a warning to us that maybe we’re already losing this drug,” said Umesh Vaidya, who runs the hospital’s 50-bed neonatal intensive care unit. “If we lose colistin, we have nothing. It’s an extreme, extreme worry for us.”
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The more than half-century-old drug, spurned by doctors for decades because it damages the kidneys, came back into vogue in recent years after less toxic broad-spectrum antibiotics began to fail. Colistin has since saved thousands of patients — a track record some researchers say is threatened by its indiscriminate use on farm animals, which may be passing on drug-resistant germs to unwary consumers.
Scientists in China reported in November a colistin resistance gene called mcr-1 that can spread among and across different species of common bacteria, heralding a wave of untreatable ailments — from urinary tract infections to pneumonia.
Selective pressure
The use of colistin on farms may be to blame for the drug’s demise, said Jianzhong Shen, a professor of veterinary medicine at Beijing’s China Agricultural University. “The selective pressure imposed by increasingly heavy use of colistin in agriculture in China could have led to the acquisition of mcr-1 by E. coli,” he said.
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Since November, the resistance gene has been reported in at least 20 more countries and prompted calls to curb the drug’s use in animals. In India, where colistin is used by some farmers to promote growth and prevent disease in poultry flocks, hospital laboratories are finding colistin resistance in as many as 10-to-15 percent of specimens tested, said Abdul Ghafur, an infectious diseases physician at the Apollo Hospital in Chennai.
“If we look for mcr-1, we will definitely find it in India,” said Ghafur, who convened the first meeting of Indian medical societies in 2012 that led to a national plan to tackle antibiotic resistance. “If it’s in China, it should be in India also.”
Investigations are already under way. At New Delhi’s All India Institute of Medical Sciences, Vinod Paul and colleagues have tracked about 90,000 newborns to gauge the burden of drug-resistant infections and to identify their genetic causes, including mcr-1. The findings are being reviewed for publication, possibly by mid May, said Paul, who heads the hospital’s pediatrics department.
Consultant microbiologist Camilla Rodrigues hasn’t found the gene in about 100 specimens of colistin-resistant bacteria collected at Mumbai’s P.D. Hinduja Hospital since 2011, she said. “We’ve just been lucky so far,” said Rodrigues, who chairs the private hospital’s infection-control committee. “Once it shows up, it will be the beginning of the end. We are very worried about it.”
Pediatrician Vaidya said his neonatal patients with colistin-resistant infections had been transferred from other hospitals, where they had received multiple antibiotic treatments. Doctors, too, are often quick to prescribe colistin, especially if a sick child starts to deteriorate, he said.
“It plays to their anxieties,” Vaidya said. “Unfortunately, there is no tight regulation on prescribing. Every clinician will prescribe it according to his whims and fancies.”
Sales of colistin for human use in India have more than doubled since 2013 to 1.2 billion rupees ($18 million) in the year ended February, according to data from AIOCD Pharmasofttech AWACS Pvt., a pharmaceutical market research company based in Chennai.
Pigs and poultry
