Plagues, Pestilences and Diseases
Drug-resistant 'superbugs' hit 20 states, rapidly spreading worldwide
By Steve Sternberg, USA TODAY
Bacteria that are able to survive every modern antibiotic are cropping
up in many U.S. hospitals and are spreading outside the USA, public
health officials say.
The bugs, reported by hospitals in more than 20 states, typically
strike the critically ill and are fatal in 30% to 60% of cases. Israeli
doctors are battling an outbreak in Tel Aviv that has been traced to a
patient from northern New Jersey, says Neil Fishman, director of
infection control and epidemiology at the University of Pennsylvania
and president of the Society of Healthcare Epidemiologists.
The bacteria are equipped with a gene that enables them to produce an
enzyme that disables antibiotics. The enzyme is called Klebsiella
pneumoniae carbapenamase, or KPC. It disables carbapenam antibiotics,
last-ditch treatments for infections that don't respond to other drugs.
"We've lost our drug of last resort," Fishman says.
Carbapenam-resistant germs are diagnosed mostly in hospital patients
and are not spreading in the community. They're far more common
nationwide than bacteria carrying a gene called NDM-1 that made
headlines this week, Fishman says.
Those NDM-1 bacteria, named for the city of New Delhi, are rare in the
USA and have been found mainly in people who obtain medical treatment
in India, Arjun Srinivasan of the U.S. Centers for Disease Control and
Prevention said Thursday.
Although KPCs are most common in New York and New Jersey, Srinivasan
says, "they've now been reported in more than half of the states." A
decade ago, only 1% of Klebsiella pneumoniae bacteria reported to CDC
by hospitals were carbapenam-resistant. Today, resistance has spread to
more than 8% of these bacteria. No one knows precisely how many people
have KPC infections because cases aren't routinely reported to the CDC.
"We see a ton of the KPC organisms," says Yoko Furuya, medical director
of infection control in New York Presbyterian Hospital. "It started in
2002-2003. They just somehow established themselves in nursing homes
and hospitals. We always have some patients, five to 10 at a time, in
the hospital with this problem."
Doctors say the bacteria are more worrisome than another well-known
superbug, methicillin-resistant Staphylococcus aureus (MRSA), because
more drugs are available to treat MRSA, Fishman says. "When MRSA
started to develop 15 years ago, industry started producing antibiotics
now coming onto the market," he says. "We're in the same position with
KPCs as we were with staph aureus 15 years ago, except that the
pharmaceutical industry isn't rushing to produce new drugs."
One of the only drugs that combats these bugs is polymixin, which was
all but abandoned years ago because it is so toxic to the kidneys,
Fishman says. As a result, he says, prevention is crucial.
In March 2009, the CDC gave hospitals new guidelines for prevention.
Among other things, doctors treating any patient diagnosed with
carbapenam-resistant infections are advised to wear gowns and gloves to
protect themselves and make sure they don't infect other patients.