New Delhi: Even as the crisis of antibiotic resistance looms large, an international team of doctors has found that waster water treatment facilities, including where chlorination of drinking water is done, are hotspots for spread of the multidrug-resistance organisms or superbugs.
Focusing on the issue of antibiotic resistance, the new report, compiled by 26 leading experts from around the world including India and published in the British medical journal The Lancet Infectious Diseases, has called for developing a global code of conduct for antibiotic use and strategies to deal with antibiotic resistance.
Dr Chand Wattal, Indian author of the report and Chairperson of Department of Microbiology at Sir Ganga Ram Hospital here, said, "Waste water treatment facilities can be a hotspot. The chlorination of drinking water can, in fact, concentrate some antibiotic resistant genes."
"One of our key recommendations is for increased research on how to reduce and neutralise man-made antibiotic pressure and how to control the resistance pool in hotspot environments," added Wattal.
According to the report, in India, E-coli isolated from urine cultures of pregnant women in their first trimesters showed highest overall resistance to antibiotics like ampicillin, naladixic acid, and co-trimoxazole by 75 per cent, 73 per cent, and 59 per cent, respectively between 2004 and 2007.
Moreover, 30 per cent had shown resistance to injectable antibiotics such as amino-glycosides, the report said about its findings in India.
In a study of bloodstream infections, the proportion of E-coli producing ESBLs, an enzyme that can break the commonly used antibiotics rendering them ineffective, has increased from 40 per cent in 2002 to 61 per cent in 2009, and the proportion of K pneumonia with carbapenem resistance increased from 2.4 per cent to 52 per cent, the report stated.
The report concluded that there is a need for global concerted actions to deal with the serious threat to public health caused by the rapid loss of antibiotic effectiveness.
The authors advocated for a health system "thinking approach" in the efforts to contain antibiotic resistance.
Wattal said antibiotic resistance arises when bacteria evolve mechanisms to withstand the drugs which are used to fight infection.
"Recent decades have seen vast increases in the use of antibiotics across medicine and agriculture, and in the absence of adequate regulatory controls, treatment guidelines, and patient awareness, this has led to a huge global surge in antibiotic resistance," said Wattal.
The report`s lead author Dr Ramanan Laxminarayan, research scholar at Princeton Environmental Institute and Public Health Foundation of India, stressed that the environment plays a key role in the spread of resistance.
"Many drivers of antibiotic consumption are grounded in human medicine. However, antibiotic use in veterinary medicine and for growth promotion and disease prevention in agriculture, aquaculture and horticulture is also a major contributing variable," said Wattal.
In the report, it was observed that there is a very low antibiotic resistance in polar bears on the isolated Arctic area and higher resistance in animals living closer to human settings.
Calling for a bolder intervention outside hospitals and toward an ecological antibiotic stewardship, the authors have recommended development of strategies focused on the control of non-human sources of antibiotics, resistant bacteria, and resistant genes, such as in agriculture and waste water from the pharmaceutical industry.
Treatment for bacterial infections is a fundamental prerequisite for fulfilment of health related Millennium Development Goals and access to effective antibiotics should be included in the discussions of the post- 2015 Developmental Goals.
The report also called for governmental coalitions to create global funding mechanisms for needs driven research and development of antibiotics, alternative treatments, diagnostics and vaccines.
It said that a global code of conduct should be developed for antibiotic use and implementation of strategies against antibiotic resistance.