We're running out of options By Matt McMillen
WebMD Health News The first U.S. case of a bacterial infection that can’t be treated by a last-resort antibiotic has been reported in a 49-year-old Pennsylvania woman. She was found to have a type of E. coli bacteria that carries a gene resistant to colistin, an antibiotic used when others don’t work. Antibiotic-resistant bacteria are difficult to treat and have become a grave — and growing — concern. The CDC estimates that at least two million people are infected with such bacteria each year, and 23,000 die. To better understand what this means, WebMD spoke with infectious diseases specialist William Schaffner, MD, medical director of the National Foundation for Infectious Diseases and a professor of medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, TN. WebMD: What type of bacteria did the woman have? Schaffner: The bacteria that the woman had is a very simple E. coli. This is a very common bug that we all have in our intestinal tract, and she apparently had it in her bladder, probably because of a urinary tract infection. WebMD: Why are health officials concerned? Schaffner: Health officials have been concerned about this because, over the years, bacteria have become increasingly resistant to our antibiotics. It’s a growing problem. We in infectious diseases now often see patients with very serious infections that can’t be effectively treated with many of the available antibiotics. In such cases, we have very few alternatives left, and some of those alternatives are quite toxic. WebMD: Does this really mean ‘the end of the road’ for antibiotics as we know them? Schaffner: This particular event does not mean by any stretch that we are at the end of the road for antibiotics, but the road is narrowing, and our options for treatment are becoming more constrained. This is not going to be an immediate threat, as these are still rare events, but this type of occurrence is the ‘poster boy’ for the problem of antibiotic resistance. And this problem is sufficiently large that it’s gone to the level of the White House, and we now have a presidential commission that is addressing antibiotic resistance. WebMD: Has this bacteria been found before? Where? Schaffner: This form of resistance was first reported about a year ago in China. Since then it has been detected in Europe, but this is the first detection of it in a patient in the United States. We don’t yet know the source of this patient’s infection. We don’t have a lot of information because it is the early days of the investigation. WebMD: Are there other ‘superbugs?’ Schaffner: If we call superbugs those that are resistant to multiple antibiotics, the short answer is yes. They may not be completely resistant, but they are certainly super at creating anxiety among infectious disease doctors. There are any number of them that have multiple antibiotic resistances. Some of these are bacteria that frequent hospitals; however, some of them can be acquired in the community. WebMD: How likely is it this bacteria will show up in other people? Schaffner: The likelihood of it spreading to others is a very good question, and it’s foremost in the minds of the public health investigators who are involved. They are gathering a list of all the contacts of this patient, and they will be getting in touch with those people and asking them to cooperate and to provide specimens to see whether and, if so, how widely this bug has spread. We hope not at all, but it needs to be tested because people who are close to each other touch each other, kiss each other, hug each other, live with each other, prepare food for each other. It is possible that this lady could have transmitted this bug to others. If we find other people who are infected with this bacteria, though they may not have symptoms, then we’ll get into a chicken-and-egg question: Did it come from the lady to that person or from that person to the lady? Who had it first? WebMD: Was it something particular about this one person? Schaffner: The information we’ve been given so far is limited, and we’re all waiting for the other shoe to drop. The one small fact that we have been provided is that she has not traveled out of the country in the past five months. That’s to address the question concerning contact (with someone who had the bacteria) in Europe or perhaps in China. But that raises a question: What happened before those five months? And where did she go? People can be infected without symptoms with a bacteria such as this for really long periods of time. WebMD: How will health officials monitor this superbug? Is there any way it can be treated? Schaffner: Fortunately, there are very few patients for whom every antibiotic is useless, so you do have alternatives. But in those rare instances, you just have to do your best and provide symptomatic care and hope that the patient’s body can overcome the infection. That’s a rather bleak prospect. Let’s be honest about that. None of us want to move in that direction. At the moment, diagnostic laboratories are alert for the possibility of such superbugs and are prepared to identify them. Even when bacteria are less super but still resistant to multiple antibiotics, physicians are notified about that. We are taking infection control precautions within hospitals to prevent their spread. It’s really a very high priority area of public health. WebMD: Are there any drugs in development that can treat emerging superbugs? Schaffner: Antibiotic development has been the traditional province of the pharmaceutical industry for many years. But the industry has found that the development of antibiotics is not very cost effective. It’s much more profitable for them to develop drugs that people take daily for long periods of time, such as blood pressure and cholesterol lowering medications. Antibiotics, by contrast, are only taken for a very short time. And to develop a drug that will be put on the shelf and only used in very restricted circumstances – that’s a terrible business model. But the Infectious Diseases Society of America has been working with Congress and with industry to create incentives for the pharmaceutical industry to reopen its antibiotic research laboratories. WebMD: What are the most important things consumers can do to prevent antibiotic resistance? Schaffner: Number one: Take your antibiotics completely and as prescribed. Number two: Don’t self-medicate and take your Aunt Suzie’s antibiotics because if you take the wrong drug or take a drug in the wrong dose or for not long enough, that promotes resistance. Number three, and very important: Don’t expect an antibiotic prescription every time you go to the doctor with a sore throat or the sniffles or a cough. You’re likely to have a viral infection, and the antibiotic is not going to do any good. Also, those of us who prescribe antibiotics have to become even more prudent and careful and restrictive in how we do that. SOURCE: http://blogs.webmd.com/webmd-interviews/2016/05/treating-superbugs-the-road-is-narrowing.html
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