A woman in the US died after being infected by a superbug most likely during her visit to India, say doctors who found that the "nightmare" bacteria was resistant to all available antibiotics.
Source: NDTV NEWS DESK | Updated: January 16, 2017 10:23 IST
The infection was caused by carbapenem-resistant Enterobacteriaceae (CRE), a multidrug-resistant organism associated with high mortality. CRE have been labelled as a "nightmare" bacterium not only because they are already resistant to most antibiotics, but also because they spread easily in hospital settings.
While CRE are not new to the United States, what was new in this case was that the infection was resistant or non-susceptible to all available antimicrobial drugs, researchers said. The US Centres for Disease Control and Prevention's antimicrobial testing showed the CRE isolate was resistant to 26 different antibiotics, including all aminoglycosides and polymixins - another class of last-resort antibiotics. It was also intermittently resistant to tigecycline, an antibiotic developed specifically to overcome drug-resistant organisms. Essentially, there were no treatment options.
The 70-year-old patient in the US was admitted to an acute care hospital in Reno, Nevada last year after an extended trip to India. She had spent considerable time in India, where multi-drug-resistant bacteria are more common than they are in the US. She had broken her right femur — the big bone in the thigh — while in India a couple of years back. She later developed a bone infection in her femur and her hip and was hospitalized a number of times in India in the two years that followed. Her last admission to a hospital in India was in June of last year.
Meanwhile, the patient's condition was deteriorating quickly. She died of septic shock in early September last year, less than two months after admission.
"We feel comfortable saying that she most likely obtained the bug in India," said Lei Chen, senior epidemiologist with the Washoe County Health District in the US.
CRE have been labelled as a "nightmare" bacteria not only because they are already resistant to most antibiotics, but also because they spread easily in hospital settings.
When CRE bacteria enter the bloodstream, they can be deadly. CRE bacteria kill up to half of patients who get bloodstream infections from them.
Postmortem tests showed her infection might have responded to a treatment called fosfomycin, which is not approved in the United States.
"This is important because we are seeing increasing numbers of drug-resistant infections, and this is one of the first cases for Klebsiella where no drug options were open to the medical staff", added Dr. Chen.
"The report highlights international travel and treatment overseas as a feature in the introduction of this pan-resistant isolate into the USA," he said.
"Since we live in such an interconnected society, this is important because this isolate represents a truly untreatable infection" which leaves health-care professionals with few options but to seek to prevent further transmission.
Why did this infection become untreatable?
This lady received multiple courses of antibiotics overseas for a bone infection and the result was the development of the CRE infection. Without knowing the exact details of the treatment in India, one could speculate that early evacuation to the US might have cured this illness at an early stage so that multiple courses of antibiotics need not have been administered—the result being eventual multi-drug resistance.
Once bone gets infected (called osteomyelitis), surgical removal of infected bone may be required. This was not done in India.
Take home message: You should purchase medical evacuation insurance prior to traveling overseas, especially to countries where medical care can be variable. Consider return to the US for early treatment after consultation with your primary care doctor in the US or other physicians who may be involved in your care.
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