Maryn McKenna

Journalist and Author

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Resistant 'Nightmare Bacteria' Increase Fivefold in Southeastern U.S.

July 26, 2014 By Maryn Leave a Comment

Klebsiella, Janice Carr, CDC

Klebsiella, Janice Carr, CDC

There’s worrisome news here in the southeastern U.S., buried in a journal that is favorite reading only for superbug geeks like me. The rate at which hospitals are recognizing cases of CRE — the form of antibiotic resistance that is so serious the CDC dubbed it a “nightmare” — rose five times over between 2008 and 2012.

Within that bad news, there are two especially troubling points. First, the hospitals where this resistance factor was identified were what is called “community” hospitals, that is, not academic referral centers. That’s an important distinction, because academic medical centers tend to be where the most cutting-edge care is performed, and where the sickest people are. As a result, they are where last-resort antibiotics are used the most, and therefore where resistance is most likely to emerge. That CRE was found so widely not in academic centers, but rather in community hospitals, is a signal that it is probably moving through what medicine calls “the community,” which is to say, anywhere outside healthcare. Or, you know, everyday life.

A second concern is that the authors of the study, which is in Infection Control and Hospital Epidemiology, assume that their finding is an underestimate of the actual problem.
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Filed Under: Science, Science Blogs, Superbug Tagged With: CDC, CRE, Klebsiella

The 'NIH Superbug': A New Case, And An Overlooked Resource

September 17, 2012 By Maryn Leave a Comment

News, via the Washington Post‘s hard-working health reporter Brian Vastag: After 6 months with no cases, carbapenem-resistant Klebsiella has surfaced again at the Clinical Center of the National Institutes of Health, and has killed a boy from Minnesota who came to the specialty hospital after a bone-marrow transplant meant to address an immune deficiency. This sad event makes the boy the 19th patient to contract the extremely resistant hospital organism, and the 12th to die from it, since the outbreak began.

You can find here my last post analyzing this outbreak (which was originally reported by the Post following a write-up by NIH staff in the journal Science Translational Medicine). I’m looping back to the subject not just because of this new death, but also to add a few new publications to the discussion, one of them mine.

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Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CRKP, Klebsiella, KPC, NIH, Resistance, SciAm, Science Blogs

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

September 12, 2012 By Maryn Leave a Comment

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…]

Filed Under: Science, Science Blogs, Superbug Tagged With: E. coli, ICAAC, Klebsiella, NDM-1, pets, Science Blogs

The 'NIH Superbug': This Is Happening Every Day

August 24, 2012 By Maryn Leave a Comment

I mentioned in my last post that I’ve been away on assignment and have been trying to catch up to an onslaught of news. One of the things that broke while I was gone was a new paper in Science Translational Medicine describing the ferocious impact on a hospital at the National Institutes of Health of the arrival of carbapenem-resistant Klebsiella pneumoniae, known for short as KPC or CRKP.

Even though the news is now several days old — the paper went live at noon Wednesday and has been covered in most major media since — I think it’s worth doubling back to take a closer look. Because, with all respect to my media colleagues, I think some of this week’s stories have omitted the larger context. So, a different kind of post for me — less news, more analysis, based on this book, this magazine story, and these past posts on antibiotic resistance. Here we go:

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Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, carbapenems, CDC, CRKP, Klebsiella, KPC, NIH, Resistance, Science Blogs

Running Out of Antibiotics: Europe Gets It

November 20, 2011 By Maryn Leave a Comment

In the United States, it’s been “Get Smart About Antibiotics” Week this past week, an annual observance in which the Centers for Disease Control and Prevention and its medical and public health partners try to raise awareness of antibiotic resistance. The real action this week though was in Europe, where individual researchers and the EU’s version of a CDC — the European Centre for Disease Prevention and Control — are speaking out about the problem with unusual candor.

Here’s the short version: In Europe, according to the ECDC, 25,000 people each year die as a result of multi-drug resistant infections, causing an additional cost to society of 1.5 billion Euros ($2.02 billion): 938 million Euros ($1.27 billion) in hospital and outpatient medical costs, and an additional  596.3 million Euros ($806 million) in lost productivity.

Dr. Marc Sprenger, director of the ECDC, said Friday:

This certainly is an underestimate of the true economic impact of antimicrobial resistance. In particular, the figures were based on data for just five multidrug-resistant bacteria.The estimate was also based on a conservative figure for the cost of a day in hospital… We think the real cost of treating a patient with a multidrug-resistant infection would be higher than this. My take home message is that antimicrobial resistance is one of the most serious public health challenges that we face.

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Filed Under: Science, Science Blogs, Superbug Tagged With: agriculture, antibiotics, CDC, ECDC, Europe, Klebsiella, Resistance, Science Blogs

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

October 29, 2011 By Maryn Leave a Comment

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.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: Acinetobacter, climate, E. coli, HAI, Hospitals, Klebsiella, MRSA, Science Blogs, weather

NDM-1 in India: Drug Resistance, Political Resistance

October 16, 2011 By Maryn Leave a Comment

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.

[Read more…]

Filed Under: Science, Science Blogs, Superbug Tagged With: antibiotics, E. coli, india, Klebsiella, NDM-1, Resistance, Science Blogs, Who

The "Indian Superbug": Worse Than We Knew

September 14, 2010 By Maryn Leave a Comment

Just about a month ago, the disease-geek world was riveted by news of the “Indian superbug“: common bacteria carrying a newly recognized gene that confers profound multi-drug resistance, and that was linked to travel between Europe and South Asia, especially for medical tourism.

The gene, which directs production of an enzyme called NDM-1 for short, was briefly Bug of the Week, the spur for alarmist headlines in every Internet echo chamber and the target of denunciations by Indian politicians, who vilified the discovery as a Western “pharma conspiracy” spurred by envy of lucrative medical tourism.

And then, just as quickly as it popped into public consciousness, NDM-1 slid back under the news-radar horizon.

Or so it seemed. Researchers though remain deeply concerned about NDM-1, along with a wider array of dire resistance factors of which it has suddenly become the best-known. This week, I’m at ICAAC (the annual Interscience Conference on Antimicrobial Agents and Chemotherapy), an enormous 12,000-person meeting focused on infectious diseases and the drugs to treat them, and talk of NDM-1 is everywhere.

The news is not good. This new resistance factor has been found so far in the United States, Canada, Belgium, the Netherlands, Austria, France, Germany, Oman, Kenya, Australia, Hong Kong and Japan. Most of the isolates, the bacterial samples in which it has been identified, are susceptible to only one or two remaining antibiotics. One was susceptible to none.

“These resistant bugs,” Dr. Patrice Nordmann, a professor of clinical microbiology at the South-Paris Medical School, said in a briefing here, “have already spread all over the world.”

A brief recap:

NDM-1 was first spotted in 2008, in a 59-year-old man of South Asian origin who lived in Sweden. He was hospitalized on a visit home to New Delhi, had surgery, recovered, went back to Sweden and was hospitalized there again. At that point, physicians recognized that he had a urinary tract infection that was unusually drug-resistant. The infection was caused by a common bacterium, Klebsiella pneumoniae, but the Klebsiella possessed an unusual and worrisome ability to disable carbapenems, a class of drugs given for very resistant infections. They named the enzyme and the gene directing its production for the place where the man had apparently acquired it: New Delhi metallo-beta-lactamase, and blaNDM.

In 2009, the United Kingdom’s public-health agency sent out an alert saying the same resistance mechanism was appearing there and increasing rapidly, going from unknown in 2007 to 18 instances in the first half of 2009, most of them in people who had gone to India for medical care or had frequent family travel back and forth. In June this year, the US Centers for Disease Control and Prevention put out a bulletin about NDM-1’s first US appearance, in three patients in three different states (California, Massachusetts and Illinois), again with ties to South Asian medical care.

And then, confirming this really was something to be concerned about, last month the journal Lancet Infectious Diseases published the results of a survey for NDM-1 that the authors conducted with collaborators in India, Pakistan and the UK. They found it widely distributed in Klebsiella and E. coli in South Asia; in UK residents who had family or business ties to South Asia or had gone there for care; and also in people who had never left the UK. Shortly afterward, the World Health Organization warned governments that they should be taking this new arrival seriously.

In the few papers on NDM-1 that got rustled up in time for ICAAC, there are more details on NDM-1’s behavior in patients in Australia, Canada, Kenya and the US; the patients were infected with different organisms, but the organisms all possessed the same gene, and were all susceptible at best to one or two drugs, some new, some old and with toxic side-effects. What connects that handful of reports: much more detail on the mobile genetic elements where the NDM gene resides. It is on more than one plasmid; it can move freely between plasmids; the plasmids have been shown to move not just between individual bacteria, but also between species and genera. Overall, that adds up to a resistance mechanism that is spreading with remarkable speed — and bringing with it, as fellow-travelers on the same plasmids, even more resistance mechanisms that have not yet been delineated.

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(I can’t link to the work presented at ICAAC because it is not online, but the teams are: Nordmann and colleagues from the Hospital Bicetre in Paris; Timothy Walsh and team from University of Cardiff, who made the first identification in 2008; Brandi Limbago and colleagues from the CDC; and JDD Pitout et al. from the University of Calgary.)

But if you know a new resistance mechanism is spreading worldwide, what do you do about it? That’s the larger discussion percolating through the corridors here. Antibiotic resistance has always been a biological occurrence wrapped in layers of science, economics and politics. For NDM-1, the politics are especially difficult.

In South Asia, several of the researchers pointed out, antibiotic overuse is common, diarrheal disease is endemic, and municipal sanitation is available to only about half of the more than 1 billion population. That’s practically a recipe for the rapid spread of genetic material carried by gut bacteria — and the economic realities of the subcontinent make it unlikely that any of those conditions are going to be remedied soon. At the same time, the South Asian diaspora worldwide is millions of people, and no one wants to be in the position of blaming a country or a people for antibiotic Armageddon.

There’s a clear concern that everyday physicians may see cases of this and not know what they are seeing. These infections look like any other — or will, until the point when patients don’t get better. At that point, what appeared to be a simple urinary tract infection, for instance, can climb backward to the kidneys, enter the bloodstream, and turn deadly. “General practitioners are not used to seeing multi-drug resistant bacteria in the community,” Dr. Pitout said. “If this does become common, it will lead to a lot of failure of treatment.”

When H1N1 swine flu became a worldwide concern last year, and H5N1 flu five years before that, the World Health Organization mobilized an intricate network of influenza surveillance labs around the world to detect aberrant isolates and track their movement. Amazingly, there’s no such network for antibiotic resistance, Nordmann said. And though an international network for the detection of antibiotic resistance would have been useful before — to track the movement of MRSA, for instance — the researchers agreed it is critically needed now. But that’s not an easy demand to satisfy. The flu network is substantially supported by the governments of the countries where the labs are located (the US lab in the WHO network is within the flu division of the CDC). Governments may not have the money available, and may not agree this issue is as high a priority as the West believes.

This week, France will begin screening any new hospital patients, checking to see who has been treated in a South Asian hospital and so may be a source of NDM-1. That’s a first step, and a crucial one. “The only practical advice I can give at this moment is for physicians to ask their patients,” Pitout said. “And if you have been treated abroad and you develop a medical emergency and must be treated at home, it is very important to tell your physician.”

Image from the CDC’s Public Health Image Library.

Filed Under: Science, Science Blogs, Superbug Tagged With: ICAAC, Klebsiella, NDM-1, Science Blogs

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