A Nevada woman has died from an infection resistant to all available antibiotics in the United States, public health officials report.
According to the Centers for Disease Control and Prevention, the woman’s condition was deemed incurable after being tested against 26 different antibiotics.
Though this isn’t the first case of pan-resistant bacteria in the U.S., at this time it is still uncommon. Still, experts note that antibiotic resistance is a growing health concern globally and call the newly reported case “a wake up call.”
“This is the latest reminder that yes, antibiotic resistance is real,” Dr. James Johnson, a professor specializing in infectious diseases at the University of Minnesota Medical School, told CBS News. “This is not some future, fantasized armageddon threat that maybe will happen after our lifetime. This is now, it’s real, and it’s here.”
According to the report, the woman from Washoe County was in her 70s and had recently returned to America after an extended trip to India. She had been hospitalized there several times before being admitted to an acute care hospital in Nevada in mid-August.
Doctors discovered the woman was infected with carbapenem-resistant Enterobacteriaceae (CRE), which is a family of germs that CDC director Dr. Tom Frieden has called “nightmare bacteria” due to the danger it poses for spreading antibiotic resistance.
The woman had a specific type of CRE, called Klebsiella pneumoniae, which can lead to a number of illnesses, including pneumonia, blood stream infections, and meningitis. In early September, she developed septic shock and died.
The authors of the report say the case highlights the need for doctors and hospitals to ask incoming patients about recent travel and if they have been hospitalized elsewhere.
Other experts say it underscores the need for the medical community, the government and the public to take antibiotic resistance more seriously.
According to the CDC, at least two million people become infected with antibiotic resistant bacteria each year, and at least 23,000 die as a direct result of these infections. The World Health Organization calls antibiotic resistance “one of the biggest threats to global health.”
A grim report released last year suggests that if bacteria keep evolving at the current rate, by 2050, superbugs will kill 10 million people a year.
While scientists are working to develop new antibiotics, that takes time, and experts encourage doctors and the public to focus on prevention efforts.
One of the most important ways to prevent antibiotic resistance is to only take antibiotics only when they’re necessary.
“Drug resistance like this [case] generally develops from too much exposure to antibiotics,” assistant professor of pediatrics at Johns Hopkins University School of Medicine and director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital, told CBS News. “Every time you’re placed on an antibiotic it’s important to question if it’s absolutely necessary and what’s the shortest amount of time you can take this antibiotic for it to still be effective.”
Johnson notes that medical tourism – the practice of traveling to another country to obtain medical treatment, typically at lower cost – may no longer be worth the risk. “With this [antibiotic] resistance issue, the risk/benefit of this approach really changes and I think that people really need to be aware and seriously consider if it’s a good idea given the possibility of this kind of thing,” he said.
Frequent hand washing, particularly in healthcare settings, is also extremely important in preventing the spread of germs.
Finally, Johnson says the public can play an important role in advocating for prevention of antibiotic resistance. While important to develop new antibiotics, “the efforts are not as strong for helping us use our existing antibiotics intelligently,” he told CBS News.
“There’s definitely something sexy about the notion of developing the ‘new super antibiotic’ to fight the superbug. It’s like a cartoon with our mega hero against our mega villain,” Johnson said. “But really we have a lot of great antibiotics right now but we’re using them in silly ways. There are organized, systematic ways that public health systems, healthcare systems, and for that matter veterinary and animal food production systems, can roll out to use our existing drugs more sensibly to slow down the freight train that is heading toward – or partly going off -- the cliff with antibiotic resistance.”
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Nevada Woman Died From Near-Ultimate Superbug
A Nevada woman who had traveled to India died from a rare superbug that could not be killed by any antibiotic available in the U.S., doctors said Friday.
It's not the first U.S. death from a near-ultimate superbug, but it's a reminder that unkillable bacteria are evolving and spreading, public health experts said.
"We have a shrinking world," said Randall Todd of the Washoe County, Nevada health department.
The woman, in her 70s, died last August. Tests showed she had been infected with an antibiotic-resistant bacterial group called carbapenem-resistant Enterobacteriaceae (CRE). Worse, this one carried a feared mutation called NDM-1.
CRE refers to a family of drug-resistant bacteria. They've evolved so that a whole class of antibiotics cannot kill them, making them into what are known as superbugs. If they get into the bloodstream and cause an infection, CRE germs kill half their victims.
The NDM-1 mutation makes it even more drug-resistant. While most CREs in the U.S. can be killed with some last-ditch antibiotics, those carrying this mutation resist even more types of antibiotic. Worse, it's often unpredictable which drug will work.
Luckily, quick-thinking hospital staff isolated her soon after she was admitted in August and no one else caught the infection, Dr. Lei Chen of the Washoe County Health District told NBC News.
Chen and colleagues described the case in the Centers for Disease Control and Prevention's weekly report on disease.
Tests showed the bacteria carried the NDM-1 mutation and no drug available in the U.S. treated the infection. Even the last-ditch antibiotic, one called colistin, failed to help.
"The patient developed septic shock and died in early September," they wrote.
"During the two years preceding this U.S. hospitalization, the patient had multiple hospitalizations in India related to a right femur fracture and subsequent osteomyelitis of the right femur and hip; the most recent hospitalization in India had been in June 2016," they added.
"We feel it likely this is where the infection was acquired," Todd said. "Hospitals should be reminded that they have got to take a travel history and be open to the possibility that an uncommon infection might be responsible."
Infectious disease specialists live in fear of superbugs, which are becoming more and more common. Not only can bacteria evolve mutations that allow them to escape the effects of antibiotics, but they can swap genes with one another and change even faster that way.
Hospital staff scrambled, but everything happened too quickly, Chen said. "It happened very fast," she said. The county health department was called in and staff worked round the clock over the Labor Day weekend to identify the infection, sending samples to the CDC for specialized testing and advising the doctors treating the patient.
"It just evolved too fast. The physicians tried their best to rescue her," Chen said.
"Antimicrobial susceptibility testing in the United States indicated that the isolate was resistant to 26 antibiotics," the team wrote.
The bacteria did not resist every single known antibiotic. Testing showed it probably could be killed with an antibiotic called fosfomycin. But it's only available in pill form in the United States and is approved for use against cystitis, not the serious infection that was killing the patient. "An intravenous formulation is available in other countries," the team noted.
And the patient died before doctors could even discuss whether to try it.