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
Add to Briefcase
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 »
CFPB Decision May Reverberate to Other Agencies
59 minutes ago

"A federal appeals court's decision that declared the Consumer Financial Protection Bureau an arm of the White House relies on a novel interpretation of the constitution's separation of powers clause that could have broader effects on how other regulators" like the Office of the Comptroller of the Currency and the Federal Housing Finance Agency.

Morning Consult Poll: Clinton Decisively Won Debate
1 hours ago

"According to a new POLITICO/Morning Consult poll, the first national post-debate survey, 43 percent of registered voters said the Democratic candidate won, compared with 26 percent who opted for the Republican Party’s standard bearer. Her 6-point lead over Trump among likely voters is unchanged from our previous survey: Clinton still leads Trump 42 percent to 36 percent in the race for the White House, with Libertarian nominee Gary Johnson taking 9 percent of the vote."

Twitter Bots Dominated First Debate
2 hours ago

Twitter bots, "automated social media accounts that interact with other users," accounted for a large part of the online discussion during the first presidential debate. Bots made up 22 percent of conversation about Hillary Clinton on the social media platform, and a whopping one third of Twitter conversation about Donald Trump.

Center for Public Integrity to Spin Off Journalism Arm
2 hours ago

The International Consortium of Investigative Journalists, the nonprofit that published the Panama Papers earlier this year, is being spun off from its parent organization, the Center for Public Integrity. According to a statement, "CPI’s Board of Directors has decided that enabling the ICIJ to chart its own course will help both journalistic teams build on the massive impact they have had as one organization."

EPA Didn’t Warn Flint Residents Soon Enough
2 hours ago

According to a new report, the Environmental Protection Agency waited too long before informing the residents of Flint, Mich. that their water was contaminated with lead. Written by the EPA's inspector general, it places blame squarely at the foot of the agency itself, saying it had enough information by June 2015 to issue an emergency order. However, the order wasn't issued until the end of January 2016.


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.