Senior CDC. UK Health Leadership: "Catastrophic" Threat From Emerging CRE Bacterial Strains

As a rule, high-ranking public-health officials try to avoid apocalyptic descriptors. So it was worrying to hear Thomas Frieden and Sally Davies warn of a coming health “nightmare” and a “catastrophic threat” within a few days of each other in March. The agency heads were talking about the soaring increase in a little-known class of antibiotic-resistant bacteria: carbapenem-resistant Enterobacteriaceae (CREs). Davies, the United Kingdom's chief medical officer, described CREs as a risk as serious as terrorism (see Nature 495, 141; 2013). “We have a very serious problem, and we need to sound an alarm,” said Frieden, director of the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

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The State University of New York (SUNY) Downstate Medical Center in Brooklyn draws patients from some of the poorest neighbourhoods in New York City, so it tends to be a place where dire health trends surface. It was not part of the CDC's ICARE programme, but physicians there conduct their own bacterial surveillance to scan for emerging infectious threats. In 2003, a review of results from the centre's microbiology lab and some collaborating ones at nearby hospitals picked up something that city physicians had never seen before. Over the previous six years, a handful of patients spread across seven institutions had been diagnosed with Klebsiella infections that were partially resistant to carbapenems. “These had been infrequent and they were flying under the radar,” says John Quale, a medical researcher at Downstate. “And at about the time we picked them up, they just exploded.”

The infections were very serious. In one Brooklyn hospital outbreak, 9 out of 19 patients died. In another, two infections blossomed into more than 30 in just six months, despite stringent infection-control measures. And the organism spread around the city — from Harlem Hospital at the north end of Manhattan to Mount Sinai Hospital on the Upper East Side, and then to Saint Vincent's in Greenwich Village in the south, where one patient died of a Klebsiella infection despite doctors throwing every drug they could at it.

One of the reasons why the resistant strains spread so rapidly was that they were difficult to detect. Most clinical microbiology labs no longer painstakingly culture bacteria over days to determine which drugs they are susceptible to: instead, automated systems, which expose bacteria to graduated dilutions of drugs, can give a result in hours. But these tests, Quale and his collaborators realized, were giving misleading results and were causing physicians to give patients doses or drugs that would not work. And because the infections were not eliminated, the resistant strain could be passed on. By 2007, 21% of all Klebsiella bacteria in New York City carried the carbapenem-resistance plasmid, compared with an average of 5% across the rest of the United States3.

http://www.nature.com/news/antibiotic-resistance-the-last-resort-1.13426