Su­per­bug in in­fec­tions showed mu­ta­tion

The Tribune (SLO) (Sunday) - - News - BY PAUL SISSON San Diego Union-Tri­bune

The su­per­bug that in­fected nearly a dozen Amer­i­cans who re­cently un­der­went weight-loss surgery at a Ti­juana hospi­tal had a par­tic­u­larly nasty ge­netic mu­ta­tion that set off alarm bells af­ter pa­tients be­gan show­ing up in hos­pi­tals and doc­tors of­fi­cers with painful wounds.

The U.S. Cen­ters for Dis­ease Con­trol and Pre­ven­tion is­sued a travel warn­ing this week, no­ti­fy­ing the pub­lic that 11 Amer­i­cans who trav­eled to Ti­juana hos­pi­tals for weight-loss surgery had be­come in­fected with drug-re­sis­tant pseu­domonus aerug­i­nosa in­fec­tions dur­ing their stays.

Dr. David “Cal” Ham, a CDC med­i­cal of­fi­cer, said Fri­day that the par­tic­u­lar strain of pseu­domonus bac­te­ria in­volved in 11 con­firmed cases had met­allo-beta lac­ta­mase genes. Of­ten called “VIM” by the epi­demi­o­log­i­cal com­mu­nity, Ham ex­plained that these genes cause the mi­crobes that carry them to ex­crete en­zymes that de­stroy car­bapen­ems, a work­horse class of an­tibi­otics with some of the broad­est ef­fi­cacy in medicine.

The pseu­domonus strains that caused the Ti­juana out­break were al­ready drug re­sis­tant, Ham said. Pick­ing up car­bapenem-fight­ing chops made an al­ready se­ri­ous threat more deadly.

“VIM makes this more con­cern­ing than your run-of-the-mill, dru­gre­sis­tant pseu­domonus,” Ham said.

One pa­tient with an out­break-linked in­fec­tion has died, the physi­cian said, though it’s im­pos­si­ble to say that it was just pseu­domonus that caused that out­come.

“The pa­tient who died did have a num­ber of other un­der­ly­ing med­i­cal con­di­tions, so we can’t say for sure if this in­fec­tion was the pri­mary cause of death,” Ham said.

Though six of the cases un­der­went bari­atric surg­eries at Grand View Hospi­tal just south of the U.S. Mex­ico bor­der, Ham said that so far not a sin­gle sick­ened pa­tient was a Cal­i­for­nia res­i­dent. In­fected med­i­cal tourists came from seven states: Arkansas, Ari­zona, Ore­gon, Utah, Texas, Wash­ing­ton and West Vir­ginia.

Some of the pa­tients, Ham said, have re­ceived treat­ment with other an­tibi­otics and have seen their in­fec­tions sub­side while oth­ers are still in hos­pi­tals suf­fer­ing as doc­tors work down a dwin­dling list of avail­able op­tions.

“There are still ac­tive in­fec­tions, un­for­tu­nately,” Ham said. “Sev­eral of the iso­lates in­volved are sus­cep­ti­ble only to a cou­ple of, I would say, less-thanop­ti­mal an­tibi­otics that have sig­nif­i­cant side ef­fect pro­files.”

Pa­tients in­volved in the out­break un­der­went surg­eries from Au­gust through Novem­ber with one case sub­se­quently iden­ti­fied in 2015. Two ad­di­tional sus­pected cases, Ham said, re­main un­der in­ves­ti­ga­tion.

The CDC is urg­ing doc­tors across the United States to re­port any cases of pseu­domonus so that spe­cial­ized test­ing can de­ter­mine whether VIM or a hand­ful of other prob­lem­atic mu­ta­tions that con­fer car­bapenem re­sis­tance are present.

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