Superbug immune to all antibiotics

Reports that a U.S. woman has died of an infection immune to virtually every antibiotic doctors could throw at it is adding to growing concerns medicine is losing its standoff with superbugs.

It may not be the drugresistant “apocalypse” some fear, but the case is raising new alarm over what has become one of the most serious public health threats worldwide.

The Nevada woman, in her 70s, died from septic shock in early September after contracting a superbug that was resistant to all 26 available antibiotics.

While “pan-resistant” bacteria are uncommon, “I think this is the harbinger of future badness to come,” Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota told the health news site STAT.

The woman had recently returned to the U.S. after an extended stay in India, where she had been hospitalized multiple times after fracturing her right femur.

She was admitted to a Reno hospital in August with widespread inflammation after her thigh and hip bone became infected. Testing revealed carbapenemresistant enterobacteriaceae, or CRE — a family health officials have dubbed “nightmare bacteria.” The organisms are lethal for up to half those infected.

The specific bacteria killing her were Klebsiella pneumonia, which can cause a range of infections. Worse, it carried an enzyme known as NDM-1 — ND for New Delhi — capable of defusing multiple drugs.

Unless solutions are found, run-of-the-mill surgeries, such as knee or hip replacements, as well as organ transplants, will become too risky

In reporting the case, the CDC urged hospitals to ask patients about recent travel outside the country, including any exposures to hospitals, and even considering screening for CRE.

It’s been estimated that annual worldwide deaths due to antibiotic-resistant bugs could reach 10 million by 2050, surpassing deaths due to diabetes and cancer combined.

Critics say that in Canada, government tracking of worrisome, drug-resistant microbes that sicken, by the government’s own count, an estimated 18,000 Canadians each year is patchy, and that more needs to be done to contain and control their spread.

“There are times when as many as 80 per cent of all beds in a facility are in exile because of an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) or some other nasty bug that has become difficult, or impossible, to treat in humans,” Dr. Andrew Morris, professor of medicine at the University of Toronto and Bill Tholl, president and chief executive of HealthCareCAN wrote in the Ottawa Citizen in September.

“Unless solutions are found, run-of-the-mill surgeries, such as knee or hip replacements, as well as organ transplants, will become too risky to undertake,” they said.

Cancer treatments will become “too dangerous to administer” while burn units “might as well shut their doors.”

According to a recent federal report, rates of MRSA and VRE (vancomycin-resistant Enteroccocci) haven’t decreased to levels seen before 2007, when increases in resistance began.

Canadian doctors said the U.S. report is worrisome.

“It’s very sobering as an ID (infectious disease) specialist to get a culture report showing resistance to all reported antibiotics,” said University of Alberta’s Dr. Lynora Saxinger.

It’s rare for organisms to be immune to all available drugs. Of more than 250 CRE samples collected by the CDC, 80 per cent were vulnerable to at least one drug class.

“We definitely see CRE in Canada, but not completely resistant ones — typically they’re still resistant to some of the other antibiotics we still have,” said Dr. Lori Burrows of McMaster University’s Michael G. DeGroote Institute for Infectious Disease Research in Hamilton.

Carbapenems are drugs of last resort. CRE organisms are “scary,” Burrows said, because they make an enzyme that chews up the drugs.

The gene that programs the enzyme is carried on tiny circular plasmids, or selfreplicating pieces of DNA. Bacteria not only swap the plasmids back and forth, the plasmids pick up other drug-resistant genes along the way.

“The bacteria carry them around like tool kits,” Burrows said.

“It makes them ready to kill off any drug they come into contact with.”

India — a popular destination for cut-rate medical tourism — has been called a superbug’s “perfect petri dish” because of poor sanitation and uncontrolled antibiotic use.

In one 2015 study, researchers who swabbed airline toilets from 18 international flight arriving in Copenhagen from nine cities in three world regions found flights from India had the highest level of drug-resistant bacteria.