A new report from the CDC asserts that aggressive identification and containment of antibiotic-resistant bacteria—demonstrably on the increase—is essential to maintaining world health.
In the end, we might all die of the superlatives. Only this month, drug-resistant gonorrhea became Super Gonorrhea, and all the wrong people were informed.
Most of the news we report in this section of the blog is worrying, so we try to limit our coverage to things you might get later today and what you can do about them.
But a new report did get our attention. It was just published on Friday, April 6, but what lends it an air of credibility is its title: “Vital Signs: Containment of Novel Multidrug-resistant Organisms and Resistance Mechanisms—United States 2006-2017.”
The work, therefore, would have been done by the “old,” "Obama-carryover" CDC, charged with protecting the public health and doing so with real science and scientists. The portion of the report’s conclusions that are in lay language are these (verbatim):
“Despite improvements in capacity to detect carbapenemases in clinical isolates and asymptomatic carriers through ARLN, challenges remain. Transmission in one facility in a region has the potential to affect all of the facilities and patients in a region through patient sharing; therefore, recognition by health care facilities of the importance of an aggressive, early, and coordinated response is needed to ensure responses are timely and comprehensive.
“Limiting the spread of emerging forms of antibiotic resistance is a public health priority, and a timely and coordinated effort among health care facilities, local and state health departments, and CDC is needed to accomplish this goal.”
In its article about the report, CNN used plain language. “More than 200 rare antibiotic-resistant genes were found in "nightmare" bacteria tested in 2017…. The report focused on the new and highly resistant germs that have yet to spread widely. Still, a variety of resistant germs can be found in every state.”
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As the story by CNN health reporter Susan Scutti went on to explain, for the study the CDC scientists tested “5,776 isolates of antibiotic-resistant germs from hospitals and nursing homes. The CDC found that about one in four had a gene that helped spread its resistance.”
Scutti quoted Anne Schuchat, principal deputy director of the CDC, as saying the findings were surprising with respect to their high number. "Two million Americans get infections from antibiotic resistance, and 23,000 die from those infections each year," Suchchat said at a press conference. "This wasn't just a problem in one or two states."
The 221 rare genes were found in isolates gathered in 27 states from infection samples that included pneumonia, bloodstream infections and urinary tract infections, Scutti wrote.
“During followup screening, nearly one in every 10 contacts also tested positive,” Scutti continued, 'meaning the unusual resistance had spread to other patients and could have continued spreading if left undetected,’ according to Schuchat. It is unknown how frequently ‘asymptomatic carriers’ spread the disease to uninfected people, she noted."
Scutti provided this helpful, clear background:
“In 1988, health officials in the United States learned that some germs within one family of bacteria, Enterobacteriaceae, could produce an enzyme capable of breaking down common antibiotics. By 2001, the germs had begun to evolve, becoming more resistant to carbapenems and other antibiotic drugs. These carbapenem-resistant Enterobacteriaceae, or CRE—dubbed ‘nightmare bacteria’ by the CDC—spread rapidly in the US and around the globe.”
The CDC has since promoted a “containment strategy.” “CDC estimates show that even if only 20% effective, the containment strategy can reduce the number of nightmare bacteria cases by 76% over three years in one area,” Schuchat told CNN.
"Even in remote areas, the threat of [resistant] pathogens is real," Dr. Jay Butler, chief medical officer of the State of Alaska told CNN, which added, “Because patients transfer from hospitals and nursing homes, germs can spread across the nation.”
The report and its significance has been picked up by an array of lay news media, many of them listed in Sources/Reading section below. NBC news reported an official from the CDC as saying, “Once antibiotic resistance spreads, it is harder to control—like a wildfire.”
NBC further quoted Schuchat as saying, in more positive terms, “CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat. While they are appearing all over the place, an aggressive approach can snuff them out.”
NBC continued its report with a soberingly succinct statement: “The World Health Organization has labeled antibiotic resistance a “fundamental threat” to humanity.”
Also according to NBC, Dr. Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, past and ongoing “overuse of antibiotics” has hastened the evolution of these deadly bacteria. Price, who was not part of the CDC study, added, “Healthy people will carry these bugs without symptoms. We can spread them to susceptible people. We can become almost like a human mosquito, spreading these germs.”
The containment approach the CDC now recommends is expensive, time-consuming and labor-intensive. “[It] requires a coordinated response among health care facilities, labs, health departments and CDC through the Antibiotic Resistance Lab Network."
Schuchat told NBC, “This is a very aggressive approach but containment of new resistance germs is really important. Otherwise, we could see these new nightmare bacteria become very common and essentially untreatable.”
What is clear is that early identification of these evolving bacteria is essential, and that, once detected, routes of possible spread be identified and investigated. Some health officials say that even that is insufficient, and that what is more urgently needed is pro-active “surveillance” for these bacteria, starting at a patient’s first visit to or by a doctor.
What is clear is for those of us who are not health-care professionals or workers, that we do everything in our power not to be “mosquitos.” That starts with aggressive hygiene after visiting the sick, so that we do not become unwitting carriers. Particularly at a time when the CDC’s mission is under governmental assault, it’s up to everyone to be vigilant and appropriately responsive.