Maryn McKenna

Journalist and Author

World Health Organization: Antibiotic Resistance Grave Global Problem

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NathanReading-staph

Image: Nathan Reading (CC), Flickr

The World Health Organization has released a significant report marking what I think must be the first attempt to quantify antibiotic resistance globally. It’s a very sobering read — not just for what the data says about the advance of resistance worldwide, but also because of what the organization could not say, because the data doesn’t exist.

The numbers themselves are unsettling. Dr. Keiji Fukuda, the WHO’s assistant director general, told the press: “It’s clear that rates are very high of resistance among bacteria causing many of the most common serious infections – the ones that we see both occurring in the community as well as in hospitals … In all regions of the world, we now see that hospitals are reporting untreatable, or nearly untreatable, infections.”

But the gaps in the numbers are too: There are 194 member countries in the WHO, but only 114 had the data-gathering resources to contribute something to the report, and only 22 were able to send in data on the most important occurrences of resistance in very common bacteria. Thus it’s possible that the report could be an under-estimate, or an over-estimate. But I can’t think of a scenario in which it could be considered substantially inaccurate. Its portrait of a world in which antibiotic resistance is advancing to grave proportions ought to be taken seriously.

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CDC: Foodborne Illness in the U.S. Not Getting Better

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AnotherPintPlease (CC), Flickr

Image: AnotherPintPlease (CC), Flickr

The Centers for Disease Control and Prevention today released their annual survey of foodborne illnesses in the United States, and the news is, well, not great. In the words of the press announcement they sent out to announce the data release: “limited progress.”

The survey — technically the Foodborne Diseases Active Surveillance Network, but usually known as FoodNet — doesn’t cover the entire US; it’s a representative sample drawn from 10 sites in nine states where the CDC already has arrangements with epidemiologists and laboratory personnel. Those 10 sites, most of them at state health departments, cover 48 million people, or about 15 percent of the US population. So among that slice, in 2013, there were:

  • 19,056 lab-confirmed foodborne illnesses,
  • 4,200 of which were severe enough to cause the person to be hospitalized,
  • and 80 of which caused the person’s death.

(For context, the CDC’s extrapolation of foodborne illness nationwide, made in 2011, was 48 million illnesses, 128,000 hospitalizations and 3,000 deaths.)

The agency compared the 2013 numbers against two sets of data, one set taken covering 2010-12 and the other 2006-08. Its summation, from its report in its weekly publication MMWR:

Compared with 2010–2012, the estimated incidence of infection in 2013 was lower for Salmonella, higher for Vibrio, and unchanged overall. Since 2006–2008, the overall incidence has not changed significantly. More needs to be done.

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Serious Resistant Infections Increasingly Found in Children

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Photo: Ishai Parasol/Flickr

Photo: Ishai Parasol/Flickr

Here’s some disturbing news published late last week in the Journal of the Pediatric Infectious Diseases Society by a team of researchers from two Chicago medical institutions plus an expert analyst of antibiotic resistance: Serious drug-resistant infections in children are rising across the United States. While the rate of their occurrence remains low overall, they nonetheless increased two- to three-fold over 10 years.
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CDC Threat Report: Yes, Agricultural Antibiotics Play a Role in Drug Resistance

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Campylobacter bacteria. Image: CDC

The grave assessment on the advance of drug resistance, released Monday by the US Centers for Disease Control and Prevention, contained some important observations about the relationship between antibiotic use in agriculture and resistant infections in humans. Those observations, combined with remarks made yesterday by the director of the CDC and also with testimony given in the past by other CDC personnel, ought to put to rest what seems like a persistent meme: that the CDC has never said, or doesn’t believe, that agricultural antibiotic use plays a role in the advance of resistance.

This is important because it puts the CDC in line with a substantial body of research pointing to agricultural use playing a role in the emergence of resistance outside farm properties. With the CDC agreeing — plus, to some degree, the Food and Drug Administration — surely it’s time to move on to whether there are things that could be done to curb the risks posed by some ag practices, while respecting the role that livestock-raising in particular plays as a substantial economic sector, and as an engine in feeding the world.

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Antibiotic Use in Chickens: Responsible for Hundreds of Human Deaths?

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In the long back and forth between science and agriculture over the source of antibiotic resistance in humans — Due to antibiotic overuse on farms, or in human medicine? — one question has been stubbornly hard to answer. If antibiotic-resistant bacteria do arise on farms, do they leave the farm and circulate in the wider world? And if they do, how much damage do they do?

A multi-national team of researchers recently published their answers to both questions. Their answer: In Europe, 1,518 deaths and 67,236 days in the hospital, every year, which would not otherwise have occurred.

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News Round-Up: Food, Foodborne Illness, And Antibiotic Resistance In Food

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OK, still catching up. Today: food, foodborne illness, and antibiotic use and resistance in food — lots of news in a multi-item rundown. (Under normal circumstances, I’d give each of these items a post of its own; but since they all happened in the past few weeks, it seems better to note them and move on.)

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The Persistence of Resistance And Some Reasons Why

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Tuesday marked the start of the United States’ Get Smart About Antibiotics Week, an annual observance by the Centers for Disease Control and Prevention that tries to direct attention to the root causes of antibiotic resistance and possible fixes. (It is also European Antibiotic Awareness Day, and also the first day of Australia’s Antibiotic Awareness Week. I don’t know of other national observances; if you do, leave them in the comments!)

To mark the day and jump-start awareness, the CDC and a number of US medical and public-health organizations held press events. The observances and the policy statements that came from them were important — but reading between the lines, it is discouraging how much there is yet to do.

(By the way, constant readers: Sorry to be gone so long. Some challenges in the extended family of Casa Superbug; almost all better now, hope everything will be over by the weekend. Meanwhile…)
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Drug Resistance in Food: Chicken, Shrimp, Even Lettuce (ICAAC 4)

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A final post from the ICAAC meeting, which concluded at one end of the Moscone Center in San Francisco Wednesday just as the Apple iPhone 5 launch was beginning at the building’s other end. (Definitely a crossing of geek streams.)

There’s far too much going on at a meeting like this to cover everything. So what emerges, as journalists move around the session rooms and exhibit floors, are stories regarding whatever caught a reporter’s eye based on his or her existing interests and news sense.

What caught my eye was a lot of research into foodborne illness, and particularly into the possibility of food being a reservoir for antibiotic resistance (which, constant readers will know, is something I’m interested in). [Read more…]

"Superbug" NDM-1 Found In US Cat (ICAAC 3)

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News from the ICAAC meeting: The “Indian superbug” NDM-1 — actually a gene which encodes an enzyme which confers resistance to almost all known antibiotics — has been found for the first time in a pet, somewhere in the United States.

When you consider the close contact we have with our pets — letting them lick us, smooching them on the head, allowing them to sleep on the bed — you’ll understand why this could be such bad news. [Read more…]

E. Coli Behaving Badly: Hospitals, Travel, Food (ICAAC 2)

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A quicker post today from the ICAAC meeting because there’s lots of news coming down this afternoon. At a conference like this, where the focus is on new behavior of pathogens and new drug compounds to contain them, there is a natural focus on emerging antibiotic resistance. Out of the first two days of (hundreds of) papers and posters, here are just a few unnerving reports.

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Investigation: Drug Resistance, Chicken And 8 Million UTIs

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So, there’s this thing. A big project. An investigative project, actually. I’ve been working on it for months, and finally I can tell you about it, because it all just published, in various venues, today.

I’ve been working with a great new group, the Food and Environment Reporting Network — one of the grant-funded journalism organizations that have arisen in the wake of the collapse of mainstream journalism — on an important, under-reported topic. Which is: Over the past decade, a group of researchers in several countries have been uncovering links between the use of antibiotics in chicken production and the rising occurrence of resistance in one of the most common bacterial infections in the world.

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Food Trade Too Complex to Track Food Safety

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The data-dense graphic above may be too reduced to read (here’s the really big version), but its intricacy masks a simple and fairly dire message: The global trade in food has become so complex that we have almost lost the ability to trace the path of any food sold into the network. And, as a result, we are also about to lose the ability to track any contaminated food, or any product causing foodborne illness.

The graphic, and warning, come from a paper published last week in PLoS ONE by researchers from the United States, United Kingdom, Hungary and Romania. The group used United Nations food-trade data — along with some math that I do not pretend to understand — to describe an “international agro-food trade network” (IFTN) with seven countries at its center, but a dense web of connections with many others. Each of the seven countries, they find, trades with more than 77 percent of all the 207 countries on which the UN gathers information.

As a result, they say: “The IFTN has become a densely interwoven complex network, creating a perfect platform to spread potential contaminants with practically untraceable origins.”

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Bats, Booze, Bugs, Birds, Blood and Bushmeat (ICEID 4)

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Since I started electing to do blog coverage of scientific meetings, I’ve run into an unfortunate reality. On any meeting day, there are one or two presentations that either are strikingly newsworthy or fit into an ongoing topic that I’m already interested in, and that therefore I feel obliged to write about. That means I’m unable to cover dozens, sometimes hundreds, of other interesting papers and posters.

I feel bad about this, especially when authors stop what they are doing to talk to me. So here’s my admittedly insufficient remedy: a quick round-up of a few of the hundreds of intriguing presentations this past week at the biennial International Conference on Emerging Infectious Diseases. (Program here; it’s a pdf, abstracts not individually searchable.) Apologies to everyone whom I didn’t get to.

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Warm Weather Increases Hospital Infections, And What That Might Mean For Climate Change

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What makes hospital-acquired infections so intractable? There’s no question that some of the organisms that cause them are tricky: MRSA hangs out on the skin and and in the nostrils, and E. coli resides in the gut, making it easy for them to be carried into hospitals undetected. Hospital workers’ poor performance on hand-washing is well-documented. And recently, researchers have begun to wonder whether hospitals have missed an opportunity by not emphasizing environmental cleaning —- of rooms, computers and equipment, for instance -— given how persistently some bacteria can linger.

A new paper in PLoS One, though, says there’s another factor contributing to the problem, one that has missed consideration until now: weather. An 8-year study of infection data from 132 hospitals finds that as outside temperatures rise, in-hospital infections with some of the most problematic pathogens rise also.

The analysis is a warning to healthcare institutions to be additionally on guard when it is warm outside. But the authors say it’s also a warning to the rest of us: If global climate change raises ambient temperatures, it could increase the likelihood of deadly hospital infections as well.

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NDM-1 in India: Drug Resistance, Political Resistance

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It’s been more than a year since the “Indian superbug” NDM-1 — not actually a bacterium, but a gene that directs production of an enzyme — hit the news. The enzyme, whose acronym is short for New Delhi metallo-beta-lactamase-1, disables almost all antibiotics directed against it, leaving the bacteria in which the gene appears vulnerable to only two imperfect and sometimes toxic drugs.

The enzyme and its gene, blaNDM-1, were first identified in 2008 in people who had traveled in India or sought medical care in South Asia. Hence its name: Many beta-lactamases, enzymes that denature the very large class of everyday antibiotics known as beta-lactams, are named for countries and cities where they were first identified. Since its identification, NDM-1 has been discovered in patients in more than a dozen countries and has also been found to be widely harboured outside hospitals in India, and in surface waters and sewage there.

The unveiling of NDM-1 clearly caused embarrassment for India, and media and lawmakers there struck back, throwing around intemperate language and claiming the naming of the enzyme was a plot to derail the subcontinent’s medical-tourism industry — even though the Indian doctors had attempted to raise the alarm earlier and had been ignored.

So it seemed like a promising signal of openness when an international conference on antibiotic resistance opened in New Delhi a week ago. But in its wake, just what is going on in India — and whether its government is willing to face up to what might be an international crisis — is less clear than ever.

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Big News But: USDA Bans "Other" E. coli Strains

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Good news, but not excellent news, today from the US Department of Agriculture: It has agreed that, starting in March 2012, six more strains of E. coli will be considered “adulterants,” putting them in the same regulatory category as the much-feared E. coli O157:H7.

It is a big step, to do this. Those six bacterial bad actors — technically, E. coli O26, O45, O103, O111, O121, and O145 — are now responsible for the majority of foodborne illness caused by E.coli in the United States, causing almost twice as much illness each year as O157 does.

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Resistant Salmonella: Deadly Yet Somehow Not Illegal

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As the scale of the nationwide outbreak of Salmonella Heidelberg started to sink in Thursday — along with the stunningly large recall of 36 million pounds of ground turkey, much of it probably already eaten — there were a number of moments that made a careful listener need to stop and just think.

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E. coli: A Risk for 3 More Years From Who Knows Where

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The latest news from the European Centre for Disease Prevention and Control, the EU’s CDC, suggests that the massive outbreak of E. coli O104 is declining. The number of new cases being discovered has fallen, and the most recent onset of illness among confirmed cases was June 27. The  toll is now 752 cases of hemolytic uremic syndrome and an additional 3,016 cases of illness in 13 countries, for a total of 3,768 illnesses including 44 deaths. (The EU adjusted that total to remove 161 cases that were suspected but not lab-confirmed. It also did not include the five confirmed cases, one suspect case and one suspect death in the United States.)

But a simultaneous report from the European Food Safety Authority (EFSA) reveals that, despite the epidemic curve’s trending down, the outbreak can’t be considered over. The ultimate source — the contaminated seeds from which salad sprouts were grown — has been so widely distributed that no one really knows where they have gone or for how long they might remain for sale. One prediction, based on the probable package labeling, is that they could remain on shelves for three more years.

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Is Drug Resistance in Humans Coming From Chickens?

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There’s a new paper out in the CDC’s journal Emerging Infectious Diseases that makes a provocative claim: There is enough similarity between drug-resistance genes in  E. coli carried by chickens and  E. coli infecting humans that the chickens may be the source of it.

If it is correct — and it seems plausible and is backed by past research — the claim provides another piece of evidence that antibiotic use in agriculture has a direct effect on human health.

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