Is the U.S. on the Brink of a Superbug Outbreak?

Chicago works to cope with deadly bacteria
By Scott Warner

U.S. healthcare officials were jolted in mid-May when a microbiologist at the Walter Reed Army Institute of Research in Silver Spring, Maryland, helped identify a strain of E. coli bacteria from a 49-year-old Pennsylvania woman that tested positive for resistance to the drug colistin; that’s the antibiotic physicians use when all others fail. The resistant gene was mcr-1, the first mcr-1 gene found in bacteria from a human in the United States. The Centers for Disease Control and Prevention (CDC) then joined in a coordinated public health response.

This was a moment U.S. health officials and experts had been bracing for since the gene’s discovery late last year in China. While the U.S. patient is reported to be fine, public health officials have said they expect to find more cases.

Infectious disease experts are most worried about the colistin-resistant gene spreading to a family of superbugs known as CRE (carbapenem-resistant Enterobacteriaceae), which the CDC has called one of the country’s most urgent public health threats. In some cases, colistin is increasingly the last-resort antibiotic used against multidrug-resistant pathogens. If the gene spreads to CRE that means it couldn’t be stopped by any antibiotic.

While the resistant gene found in Pennsylvania has not appeared in the Chicago area, our region has had its own brushes with superbugs. In 2013, one of the largest U.S. outbreaks on record of CRE occurred at Advocate Lutheran General Hospital in Suburban Park Ridge, where 39 patients were infected and two died, according to the Illinois Department of Public Health. The patients were infected by contaminated duodenoscopes.

In some hospitals, antibiotic-resistant bacteria cause one in four catheter- and surgery-related infections. If this trend of antibiotic resistance continues, it could make many common surgeries and cancer treatments too risky.

Rush, Cook County Win Grants

To increase resources to combat this threat, the CDC has awarded $26 million to five academic medical center-based efforts to research new ways to control drug-resistant organisms and prevent healthcare-associated infections. The CDC announced the awards at a June 27 press conference at Rush University Medical Center.

The five grant recipients include the Chicago Prevention and Intervention Epicenter at Rush University and Cook County Health and Hospitals System, which will receive $9.45 million: $5 million from the national award plus $4.45 million from the CDC’s Safety and Healthcare Evaluation and Research Development contract to develop and test regional approaches for preventing transmission of antibiotic-resistant germs between healthcare facilities. The CDC stated that the protocols Rush and Cook County implemented have reduced CRE infections by 56%.

Also heavily involved in the campaign against superbugs are the Chicago Department of Public Health (CDPH), and the Illinois Department of Public Health (IDPH). Stephanie Black, MD, medical director for CDPH, says that both organizations are working together on an ongoing “Detect and Protect Campaign,” which includes an Extensively Drug Resistant Organism (XDRO) registry to share patient information across facilities and report CRE isolates.

In addition, Dr. Black says that CDPH assists health facilities in appropriate testing for laboratory identification of superbugs, and provides technical assistance on infection control practices. “Patients with complex medical issues often require medical devices and antibiotics, which place them at risk of infections with more drug-resistant bacteria,” she says. Dr. Black urges physicians to minimize use of medical devices and to prescribe antibiotics judiciously for the correct diagnosis, with the correct drug, dose and duration. Her concern is affirmed by a recent study from CDC that reported an estimated 154 million primary-care physician and emergency department visits each year resulted in the writing of an antibiotic prescription. Nearly half were for respiratory conditions for which antibiotics prove largely ineffective.

“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use, we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Tom Frieden, MD, in a written statement. “Losing these antibiotics would undermine our ability to treat patients with deadly infections, provide organ transplants, and save victims of burns and trauma.”