Carbapenem-Resistant Organisms Are Prevalent in Bangladeshi Environmental Samples–This Is Really Bad

grabbed in whole from Mike’s blog…

we’re playing with matches in the powder magazine, but so far everybody who could really help fix this is pretending it’s not happening

Posted on May 1, 2015 by mikethemadbiologist

We’re not going to be able to contain this (boldface mine):

Carriage of the New Delhi metallo-β-lactamase variant 1 (NDM-1) enables drug resistance to move between communities and hospitals. In Bangladesh, we found the blaNDM-1 gene in 62% of environmental waters and in fermentative and nonfermentative gram-negative bacteria. Escherichia coli sequence type (ST) 101 was most commonly found, reflecting a common global relationship between ST101 and NDM-1.

In English, when the researchers stuck swabs into different water sources in India, they were able to find genes that confer resistance to all beta-lactam antibiotics (any antibiotic that starts with cef-, ceph-, or ends with -cillin) on 62% percent of the swabs. But it gets worse.

Just about everything they isolated was also resistant to just about everything else, other than tigecycline and colistin. Colistin can damage your kidneys (and resistance can evolve rapidly within a patient), while using tigecycline for infections other than skin infections isn’t recommended (in blood, the drug just doesn’t reach high enough concentrations to be effective).

Not depressed yet? Well, many of the E. coli isolates belong to clones associated with UTI* and are common clinical clones. Here’s why that’s a problem:

Leaving aside the dire and legitimate concerns of untreatable life-threatening infections, CREs include E. coli and Klebsiella, the two most common urinary tract infection organisms**. Do you want to live in a world where a (hopefully) small percentage of UTIs can’t be treated?

For those of you in the slow microbiology group, the answer to that question is no.

This highlights the importance of clean water and adequate sanitation: when those are lacking, the substitute public health strategy (such as it is) is that people get gastrointestinal illness, and then take antibiotics to cure themselves. Then one day you realize you’re surrounded by a dilute solution of drug-resistant organisms.

In the U.S., hospitals are reacting very quickly and vigorously to carbapenem-resistance organisms, but the real concern is that these organisms can also live in our guts without causing disease. If these become established in human (or other animal) reservoirs in the U.S., we’re in a lot of trouble.

Not a good development.

*Important caveat: the authors used a medium that is designed to grow organisms from urine specimens–I have no idea why. I also don’t know if this would favor the growth of E. coli that are adapted to urinary tracts, but that could be a confounding issue here.

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