A woman in the US killed by a bacteria that is resistant to all antibiotics

Group of resistant enterobacteria. Photo: US Centers for Disease Control and Prevention

Prior to the invention of antibiotics, it was commonplace that people did not live to be 30 years old, dying from infectious diseases. If you do not invent new antibiotics, then these times may return.

Experts know that as a result of natural selection, resistance to individual antibiotics is produced by random mutations in microorganisms. Microbes are capable of carrying genetic information about antibiotic resistance through horizontal gene transfer. This is a direct demonstration of evolution in living nature, when a living creature changes its characteristics in order to become completely resistant to harmful environmental conditions. In this case, the harmful environmental conditions are human activities. Scientists believe that antimicrobial resistance is manifested as a result of the gradual accumulation of mutations over time , although it may also occur as a result of targeted genome changes of the causative agent of the disease.

Whatever the reasons for the emergence of antibiotic resistance, such organisms pose a greater threat to human life. These microbes are very hard to kill. The darkest is that antibiotic-resistant microbes can multiply over time - and the number of deaths will increase. According to the pessimistic forecast of physicians, by 2050 such bacteria will kill 10 million people a year worldwide. In the coming decades, these “superbugs” can become one of the main causes of mortality on Earth, beating cancer, death in road accidents (1.2 million people a year) and, of course, all wars and terrorist attacks combined.
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According to doctors, microbes are now partially resistant to antibiotics, killing about 700 thousand people a year . But in almost all cases it was possible to choose an effective drug. Very rarely, microbes are resistant to absolutely all antibiotics. There is always the chance that in fact the patient could be saved - maybe the doctors misused the antimicrobial drug or antibiotic, did not have time to find the right medicine.

One of the most studied cases with a proven death of a patient from a resistant microbe is documented in a scientific article that was published several days ago in the American medical journal Morbidity and Mortality Weekly Report (MMWR) .

On August 18, 2016, an infected woman was admitted to a hospital in the American city of Reno (state Nevada) with a preliminary diagnosis of "systemic inflammatory response syndrome", presumably due to infection through gray on the right thigh.

On August 19, 2016, an analysis of a sample taken from the area of ​​infection determined the presence of the Klebsiella pneumoniae bacterium, Friedlander’s bacillus. This Gram-negative facultative anaerobic rod-shaped bacterium is one of the common causative agents of pneumonia, as well as some other infectious diseases. The woman was quarantined in an isolated room. On August 25, 2016, a message on a patient with an infection that is resistant to all known antibiotics was reported to the local CDC.

A case study showed that a patient over 70 years old returned in early August after a long trip to India. For two years before, she was repeatedly hospitalized in India in connection with a fracture of the right thigh, followed by osteomyelitis, the last time in June 2016.

The patient developed septic shock, death occurred in September 2016.

Testing for antibiotic resistance has shown that the sample of bacteria is resistant to 26 antibiotics, including all aminoglycosides and polyxins, and is partially resistant to tigecycline, a special type of antibiotic developed to combat resistant microbes. Colistin and Fostomycin were tested during testing. Tests have shown the sensitivity of the pathogen to fosfomycin at relatively low inhibitory concentrations. Unfortunately, fosfomycin is permitted in the United States only for oral administration in the treatment of uncomplicated cystitis, although in other countries it can be administered intravenously. All drugs approved for use in the United States were powerless against this pathogen.

Especially noteworthy is the lack of response to colistin. The bacterium becomes resistant to this drug when it has the mcr-1 gene. Recently, scientists have noted that because of the use of colistin on pig farms in China, bacteria have developed resistance to this antibiotic, and now the mcr-1 gene is found in the genome of a large number of microbes .

Specialists at the Center for Control and Prevention of Diseases point out that they constantly monitor the occurrence of resistant bacteria, but the detection of microbes that are absolutely resistant to all antibiotics is extremely rare. Among the more than 250 cases that were analyzed during the entire observation period, more than 80% of the samples were suspected to be vulnerable to at least one type of aminoglycosides, and 90% to tigecycline.

The Center for Disease Control and Prevention warns of the need to take appropriate quarantine measures in the event of the discovery of such bacteria in order to prevent the spread of infection. Additional safety measures should be taken for patients who have recently come from India or other regions in which the existence of antibiotic resistant microorganisms is known.

The problem is very serious. It will be very difficult to fight an infectious disease if the pathogen is resistant to all known antimicrobials. “I think it is alarming. We have relied on all new and new antibiotics for so long. But it is obvious that microbes can often develop resistance faster than we can produce new drugs, ” says Alexander Kallen, an employee of the regional center for disease control and prevention.

The situation is complicated by the fact that the procedure for testing new antibiotics takes a very long time, and some pharmaceutical companies have completely abandoned the development of new drugs. For example, the pharmaceutical company Cempra Pharmaceuticals did not receive FDA approval for its new antibiotic because of possible side effects on the liver. Pharmaceutical company Paratek Pharmaceuticals has been waiting for approval of its new antibiotic Omadicycline (omadacycline) for about 21 years, its testing continues.

The medical report was published on January 13, 2017 in the journal Morbidity and Mortality Weekly Report (doi: 10.15585 / mmwr.mm6601a7).