We believe that poor management of the hospital environment and medical waste could be one of many routes of environmental dissemination of pathogens, especially in south Asian countries. For example, in Bangladesh and India, medical facilities rarely have provision for internal waste treatment, and solid hospital waste is often disposed of without proper care on hospital premises3 and liquid waste from hospitals flows with sewage into open ditches and urban river systems.
Wild animals, and birds in particular, can carry and spread multidrug-resistant bacteria and CTX-M-carrying bacteria.4 However, the prevalence of infection in birds living close to people is probably related to the extent of antibiotic resistance in the environment.4, 5
During a research trip to Bangladesh in 2010, we analysed 150 faecal samples from gulls along the coastline and 238 faecal samples from crows in the grounds of Rajshahi Medical College Hospital and Chittagong Medical College Hospital to detect blaNDM-1 expression.
via Dissemination of NDM-1 : The Lancet Infectious Diseases.
