What to Know About the Drug-Resistant Superbugs That Killed 23,000 Last Year

A Q&A with a CDC scientist.

Methicillin-resistant Staphylococcus aureus (MRSA, brown) surrounded by cellular debris.
National Journal
Brian Resnick
See more stories about...
Brian Resnick
Sept. 23, 2013, 7:43 a.m.

We cre­ated the night­mare bac­teria.

It wasn’t on pur­pose. We could not have in­ven­ted an­ti­bi­ot­ics without spur­ring bac­teri­al evol­u­tion. As long as there were some bugs out there im­mune to the drugs, the pop­u­la­tion would ad­apt. Just a few years after an­ti­bi­ot­ics came in­to mass use in the 1940s, sci­ent­ists began to ob­serve res­ist­ance. Then, as mi­cro­bi­o­lo­gist Ken­neth Todar writes, “Over the years, and con­tinu­ing in­to the present, al­most every known bac­teri­al patho­gen has de­veloped res­ist­ance to one or more an­ti­bi­ot­ics in clin­ic­al use.” And now, some bugs are res­ist­ant to just about everything.

Car­bapenem-res­ist­ant En­terobac­teri­aceae, known as CRE or the “night­mare bac­teria,” was not known be­fore 2001. Now, 4.6 per­cent of hos­pit­als in the United States re­por­ted at least one in­fec­tion in 2012. That num­ber was 1.2 per­cent in 2001.

CRE out­breaks are the stuff of zom­bie movies, be­cause no drug ex­ists to fight them. In 2011, at a Na­tion­al In­sti­tutes of Health hos­pit­al no less, an out­break of a CRE vari­ant killed six people. CRE germs kill about half the people they in­fect, but here’s the scar­i­er part: “CRE have the po­ten­tial to move from their cur­rent niche among health care”“ex­posed pa­tients in­to the com­munity,” the Cen­ters for Dis­ease Con­trol and Pre­ven­tion re­ports.

Drug-res­ist­ant patho­gens such as CRE are mainly found in the hos­pit­al set­ting, but they are also found in the en­vir­on­ment. A Columbia Uni­versity study found drug-res­ist­ant germs to be “wide­spread” in the Hud­son River in New York, with the re­search­ers sus­pect­ing the source was un­treated sewage. The more com­monly known MRSA, con­fined to in­fec­tions in hos­pit­als in the first two dec­ades after it was dis­covered, can now be con­trac­ted from every­day sur­faces such as gym mats.

Last week, CDC re­leased the first com­pre­hens­ive re­view of the num­ber of drug-res­ist­ant in­fec­tions and deaths in the coun­try. It’s the first of its kind, com­pil­ing data from dozens of dif­fer­ent strains of bac­teria in one re­port. It finds that at least 2 mil­lion Amer­ic­ans be­come in­fec­ted with drug-res­ist­ant bac­teria every year, res­ult­ing in 23,000 deaths. The re­port stresses that these num­bers are con­ser­vat­ive, as they only take in­to ac­count in­fec­tions in acute-care hos­pit­als, not long-term cen­ters.

Re­cently, I spoke with Jean Pa­tel, one of the au­thors of the re­port and a deputy dir­ect­or of CDC’s An­ti­mi­cro­bi­al Res­ist­ance Di­vi­sion. She spoke about the need to in­crease aware­ness of an­ti­bi­ot­ic res­ist­ance and ways to com­bat its spread. Her re­sponses have been lightly ed­ited. My ques­tions have been re­ph­rased to sound slightly smarter.

Are we ap­proach­ing a fu­ture where an­ti­bi­ot­ics will be ob­sol­ete?

An­ti­bi­ot­ics are al­ways go­ing to have a role, but what we have to de­cide is to stop re­ly­ing on them as the only role. So now we have to think, and have a great­er fo­cus on pre­ven­tion of the trans­mis­sion of res­ist­ant patho­gens and us­ing an­ti­bi­ot­ics as wisely as pos­sible.

There are some in­fec­tions like strep throat where an­ti­bi­ot­ics are go­ing to be needed. But there are oth­er in­fec­tions, like up­per res­pir­at­ory tract in­fec­tions, the com­mon cold, where an­ti­bi­ot­ics are not ne­ces­sary. And your doc­tor can help guide you through that choice. I think it is im­port­ant on both sides — the doc­tor and the pa­tient — to de­cide that an­ti­bi­ot­ics aren’t al­ways ne­ces­sary.

Any threat of — or just a hy­po­thet­ic­al threat — of a drug-res­ist­ant pan­dem­ic?

I think the scary en­d­point that we are look­ing at are bac­teria that are be­com­ing res­ist­ant to all agents that could be used for treat­ing them. Right now we have some of those patho­gens, but they may be lim­ited to cer­tain pop­u­la­tions. An ex­ample is CRE. Right now, those are bac­teria that are be­com­ing res­ist­ant to nearly every drug. But right now they are only caus­ing in­fec­tions in the health care set­ting. We an­ti­cip­ate that chan­ging. We saw that hap­pen with the ESPL pro­du­cing En­terobac­teri­aceae, but it hasn’t happened yet. But we think we have some time be­fore it does hap­pen. But we need to beef up our fo­cus on pre­ven­tion.

What does pre­ven­tion look like? And what role does phar­ma­ceut­ic­al in­nov­a­tion play?

I think it needs both. On one end, we need health care pro­viders to make bet­ter de­cisions about us­ing an­ti­bi­ot­ics. And I think to do that we need more in­form­a­tion. We need to get more in­form­a­tion in the hands of those health care pro­viders so they can make the best de­cisions pos­sible.

And we’re work­ing on ex­pand­ing the scope of our abil­ity to track an­ti­bi­ot­ic res­ist­ance and also an­ti­bi­ot­ic use in health care set­tings. So a phys­i­cian would look at the an­ti­bi­ot­ic use and in their health care set­ting they’d be able to bench­mark what’s hap­pen­ing in their set­ting, and com­pare to oth­er health care set­tings.

The re­port calls for an end of an­ti­bi­ot­ics use in live­stock. How might that hap­pen?

An­ti­bi­ot­ics need to be used in the pro­cess of food-pro­du­cing an­im­als. But we are ask­ing that this be used to man­age in­fec­tions and not be used to pro­mote growth of the an­im­als. And this is con­sist­ent with what the Food and Drung Ad­min­is­tra­tion has pro­posed. So the FDA has draft guid­ance that maps out a plan for phas­ing out an­ti­bi­ot­ic use for growth pro­mo­tion in an­im­als, and in­stead us­ing these an­ti­bi­ot­ics to man­age in­fec­tions in an­im­als. And we sup­port that.

What’s the take-home les­son?

The most im­port­ant thing for the pa­tients is a fo­cus on an­ti­bi­ot­ic use. Hav­ing that con­ver­sa­tion with your phys­i­cian about wheth­er an­ti­bi­ot­ics are really needed for the ill­ness that they have.

Do we have num­bers on an­ti­bi­ot­ics mis­use?

In the health care sys­tem, we es­tim­ate that 50 per­cent of an­ti­bi­ot­ic use is un­ne­ces­sary or not ap­pro­pri­ate.

Can we ever stop the cre­ation of new drug-res­ist­ant germs?

We can slow it down. Nature will take its course wherever an­ti­bi­ot­ics are used. Res­ist­ance will emerge, but we can slow that.

What We're Following See More »
STAFF PICKS
These (Supposed) Iowa and NH Escorts Tell All
4 hours ago
NATIONAL JOURNAL AFTER DARK

Before we get to the specifics of this exposé about escorts working the Iowa and New Hampshire primary crowds, let’s get three things out of the way: 1.) It’s from Cosmopolitan; 2.) most of the women quoted use fake (if colorful) names; and 3.) again, it’s from Cosmopolitan. That said, here’s what we learned:

  • Business was booming: one escort who says she typically gets two inquiries a weekend got 15 requests in the pre-primary weekend.
  • Their primary season clientele is a bit older than normal—”40s through mid-60s, compared with mostly twentysomething regulars” and “they’ve clearly done this before.”
  • They seemed more nervous than other clients, because “the stakes are higher when you’re working for a possible future president” but “all practiced impeccable manners.”
  • One escort “typically enjoy[s] the company of Democrats more, just because I feel like our views line up a lot more.”
Source:
STATE VS. FEDERAL
Restoring Some Sanity to Encryption
4 hours ago
WHY WE CARE

No matter where you stand on mandating companies to include a backdoor in encryption technologies, it doesn’t make sense to allow that decision to be made on a state level. “The problem with state-level legislation of this nature is that it manages to be both wildly impractical and entirely unenforceable,” writes Brian Barrett at Wired. There is a solution to this problem. “California Congressman Ted Lieu has introduced the ‘Ensuring National Constitutional Rights for Your Private Telecommunications Act of 2016,’ which we’ll call ENCRYPT. It’s a short, straightforward bill with a simple aim: to preempt states from attempting to implement their own anti-encryption policies at a state level.”

Source:
STAFF PICKS
What the Current Crop of Candidates Could Learn from JFK
4 hours ago
WHY WE CARE

Much has been made of David Brooks’s recent New York Times column, in which confesses to missing already the civility and humanity of Barack Obama, compared to who might take his place. In NewYorker.com, Jeffrey Frank reminds us how critical such attributes are to foreign policy. “It’s hard to imagine Kennedy so casually referring to the leader of Russia as a gangster or a thug. For that matter, it’s hard to imagine any president comparing the Russian leader to Hitler [as] Hillary Clinton did at a private fund-raiser. … Kennedy, who always worried that miscalculation could lead to war, paid close attention to the language of diplomacy.”

Source:
STAFF PICKS
Hillary Is Running Against the Bill of 1992
4 hours ago
WHY WE CARE

The New Covenant. The Third Way. The Democratic Leadership Council style. Call it what you will, but whatever centrist triangulation Bill Clinton embraced in 1992, Hillary Clinton wants no part of it in 2016. Writing for Bloomberg, Sasha Issenberg and Margaret Talev explore how Hillary’s campaign has “diverged pointedly” from what made Bill so successful: “For Hillary to survive, Clintonism had to die.” Bill’s positions in 1992—from capital punishment to free trade—“represented a carefully calibrated diversion from the liberal orthodoxy of the previous decade.” But in New Hampshire, Hillary “worked to juggle nostalgia for past Clinton primary campaigns in the state with the fact that the Bill of 1992 or the Hillary of 2008 would likely be a marginal figure within today’s Democratic politics.”

Source:
STAFF PICKS
Trevor Noah Needs to Find His Voice. And Fast.
5 hours ago
WHY WE CARE

At first, “it was pleasant” to see Trevor Noah “smiling away and deeply dimpling in the Stewart seat, the seat that had lately grown gray hairs,” writes The Atlantic‘s James Parker in assessing the new host of the once-indispensable Daily Show. But where Jon Stewart was a heavyweight, Noah is “a very able lightweight, [who] needs time too. But he won’t get any. As a culture, we’re not about to nurture this talent, to give it room to grow. Our patience was exhausted long ago, by some other guy. We’re going to pass judgment and move on. There’s a reason Simon Cowell is so rich. Impress us today or get thee hence. So it comes to this: It’s now or never, Trevor.”

Source:
×