New Antibiotic-resistant E. coli Reaches US

New Antibiotic-resistant E. coli Reaches US

Created on: Friday, May 27, 2016
Author: Peter MIchaud

We deal with MRSA, we deal with C. diff, we deal with VRE, we deal with CRE…and many others. Now there’s a new challenge for medicine in the U.S.: colistin-resistant Escherichia coli. This bacterium, and other enterobacteria, can carry a plasmid-borne colistin resistant gene, mcr-1. According to a report[1] funded by the U.S. Army Medical Command and recently published in the journal Antimicrobial Agents and Chemotherapy, this antibiotic resistant strain of E. coli was found in April 2016 in the urine of a woman in Pennsylvania—a woman who had not traveled in the previous five months. “The recent discovery of a plasmid-borne colistin resistance gene, mcr-1, heralds the emergence of truly pan-drug resistant bacteria,” wrote the Walter Reed researchers. It appears, though, that this particular bacterium in this patient was not resistant to carbapenem.

The discovery of this bacterium is being trumpeted by the popular media in an alarming manner: “’Nightmare bacteria’ superbug” (NBC News); “A dreaded superbug” (CNN); “The superbug that doctors have been dreading” (The Washington Post); “Specter of superbugs” (New York Times); “Antibiotic-resistant ‘nightmare bacteria’” (Boston Globe). Yet the media are not the only ones making such statements. Dr. Tom Frieden, Director of the U.S. Centers for Disease Control and Prevention, said, “The medicine cabinet is empty for some patients…It is the end of the road for antibiotics unless we act urgently.”

One troubling aspect of this situation is that colistin, an older antibiotic, is used only rarely now, as a last resort treatment for CRE, because of its serious side effects such as kidney damage. Another concerning issue is raised in a letter in the journal Emerging Infections Diseases, to be published in September 2016: “These findings suggest that mcr-1-producing E. coli can colonize companion animals and be transferred between companion animals and humans.”[2]

The issue is getting the attention of political figures as well. Sen. Robert Casey, Jr. (D-PA) said recently that he supports legislation looking into antibiotic-resistant bacteria. “(They) present an urgent public health problem that we must focus on intensively.” Federal funding has gone to the CDC and other agencies, along with state and local public health agencies, to increase the ability to detect and prevent outbreaks of antibiotic-resistant bacteria, and the NIH has received funding for research into the issue.

As with many other infectious diseases, hand washing and other front line preventive measures are one of the keys to limiting the spread of new, evolving antibiotic-resistant organisms. Greater attention is also being paid to the widespread use of antibiotics in food production. This threat need not become an apocalypse.

[1] McGann P,, Snesrud E., Maybank R., Corey G., et al. Escherichia coli Harboring mcr-1 and blaCTX-M on a Novel IncF Plasmid: First report of mcr-1 in the USA, Antimicrob. Agents Chemother. doi:10.1128/AAC.01103-16, Posted online 26 May 2016.

[2] Zhang X-F, Doi Y, Huang X, Li H-Y, Zhong L-L, Zeng K-J, et al. Possible transmission of mcr-1–harboring Escherichia coli between companion animals and human. Emerg Infect Dis. 2016 Sep [May 26, 2016].

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