Antibiotic Resistance: Getting Some Well Deserved [Bad] Press

Graphic from CDC report

Some really great resources have recently been released focused on the problem of antibiotic resistance.

The first is CDC's 2013 Antibiotic Resistance "Threat Report," available here. This document outlines, in a clear and easily understandable way, the current problem of antibiotic resistance and the implications of this. Basically, the following is true:

1) Antibiotic resistance is complex and ancient
2) Antibiotic use (appropriate and inappropriate) drives resistance
3) Resistance has outpaced the development of new antibiotics
4) Certain organisms are particularly worrisome: some have developed resistance to all known antibiotics

The report is definitely worth taking a look at and is a compelling, easy read.

Graphic from CDC report

The next resource is a "FRONTLINE" segment called "Hunting the Nightmare Bacteria," available here.
This video powerfully captures just how nightmarish the problem of antibiotic resistance is.

I lecture about antibiotic resistance to college and medical students and often quote from Sir William Osler's* 19th century medicine textbook where he states:

"The treatment of septicaemia and pyaemia is largely a surgical problem... we have no remedy... the brilliant and remarkable results which follow complete evacuation of the pus with thorough drainage give the indication for the only successful treatment of this condition."

Picture of "bloodletting" in 1860s
(wikipedia.org)

Essentially what he is saying is that for some patients with serious infections the only chance for cure (and often survival) is to cut the infected part out; this is 19th century medicine prior to the development of antibiotics.

What is alarming is that for many patients we have returned to practicing 19th century medicine; this is expertly, and disturbingly illustrated in the FRONTLINE segment. The two patients highlighted in the show had essentially untreatable infections and to achieve cure the infected tissue had to be surgically removed.

It has only been 70 years since the widespread introduction of antibiotics in the 1940s and many patients have already entered the "post-antibiotic era." Both the CDC report and the FRONTLINE segment highlight just how dire this problem is and are well worth taking a look at.

*Many consider Sir William Osler to be 'the father' of modern internal medicine 

The "Superbug" Problem: What Does the CDC's CRE Report Really Mean?

The Great Wave off Kanagawa (wikipedia,
Library of Congress)

Hi everyone! I am back after a long hiatus (vacation and lots of time on the medicine wards/ infectious disease consult service).

I was interviewed this morning by a local radio program about the "Superbug" problem and antibiotic resistance (you can find the interview here, if interested).

This interview was requested, in part, by the recent CDC report on carbapenem-resistant Enterobacteriaceae ("CRE"), and the media coverage that has followed the release of this disturbing report.

Enterobacteriaceae are a group of organisms that typically inhabit the gastrintestinal tract. They are a major problem, especially in hospitals, where they can cause urinary tract infections UTIs), bloodstream infections and wound infections.

CRE are extremely antibiotic resistant bacteria; in some cases these bacteria are resistant to all known antibiotics. Carbapenems are a class of antibiotics often reserved for the sickest, most unstable patients; unfortunately, for CRE, these agents do not work. Not surprisingly, CRE infections have been associated with very high mortality (upwards of 50%). In the case of many of these infections we truly are realizing the "post-antibiotic era," and a return to pre-20th century medicine.

The CDC report notes that during the first 6 months of 2012 nearly 5% of all hospitals reporting on healthcare-associated infections (in this case, UTIs and bloodstream infections) reported at least one CRE infection. When broken down by hospital type, a whopping 17.8% of long-term acute care hospitals reported one of these infections (almost 1 in 5 of all such facilities!). Overall, comparing data from 2001 and 2011, the percentage of Enterobacteriaeceae that were carbapenem-resistant (e.g, CRE) went from approximately 1% to 4%. Looking at one of these organisms in particular (Klebsiella) resistance went from 2 to 10%!

The reality in 2013 is that a person can be admitted to the hospital for a hip replacement, develop a UTI with CRE, and die from the UTI because there are no effective antibiotics to combat the infection. Unless we act now, and decisively, as a society/ global community, we truly are at risk of entering the post-antibiotic era.

In reading about this issue the CDC has some terrific information. For the best commentary I have seen I refer you to the posts over at Controversies in Hospital Infection Prevention.

Only time will tell whether we have the collective wisdom and will to preserve the antibiotics we have, develop new drugs and curb the emergence of antibiotic resistance. If the looming problem of pan-antibiotic resistant organisms is a tsunami, let us have the wisdom to heed the warning of the CDC's CRE report, and get to high ground. As it stands, I fear we will collectively be asleep in bed when the wave breaks.