Government responds quickly to resistant superbug detection, but is it enough?

An antibiotic-resistant superbug observed in other countries, especially China, was found in a Pennsylvania woman. This bacteria is resistant to colistin, the “antibiotic of last resort” for many stubborn infections. Although colistin, a 50-year-old drug, has its problems, it was a life-saving option particularly for those in intensive care. Despite recent funding provided for the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and HHS’ Biomedical Advanced Research and Development Authority (BARDA) earmarked for antibiotic development, physicians are extremely concerned about the implications of living in a “post-antibiotic world.”

Bacteria

The bacteria found in the patient was a particularly nasty strain of E. coli, which the Washington Post reported became infected itself with DNA that carries a gene for antibiotic resistance, mcr-1.  The CDC, other agencies, and physicians have been concerned about Carbapenem-resistant Enterobacteriaceae (CRE) for some time, which generally present in health care settings, as there is some indication that the mortality rate for those infected is 50 percent. Department of Defense (DOD) researchers stated that the patient had not traveled within the last five months, and are still assessing the presence of this bacteria in the population.

Colistin and resistance

Colistin was developed decades ago, but fell out of widespread use when new alternatives appeared due to its side effects. In particular, colistin can result in kidney damage in patients exposed to higher doses. The drop in popularity served colistin well, as the lack of use did not give bacteria the opportunity to develop a resistance. Yet when the risks of infections resistant to other bacteria outweighed potential kidney damage, doctors turned back to colistin, which was never subject to strict FDA regulations and widespread studies. Teams from the NIH began studying the drug’s effect on the kidneys, but only reported preliminary findings in 2012 and has not updated its publicly available results.

Colistin-resistant bacteria was first observed in China, which uses the cheap antibiotic in agricultural settings. Chinese researchers  discovered this type of bacteria in a pig in 2013.  Although colistin is approved for agricultural use in the U.S., it is not used in animals in this country. However, the government has detected the presence of resistant bacteria in an American pig. At the end of 2015, after colistin-resistant bacteria was found in England and Wales in both pigs and humans, the British director of antibiotic research stated that it was almost too late to recover from the threat of superbugs, giving researchers the grim odds of 50%.

Government response

The threat of a completely resistant bacteria has been looming for some time, prompting President Obama to release the National Action Plan to Combat Antibiotic-Resistant Bacteria in March 2015. The action plan consisted of five goals: slowing the emergence of resistant bacteria, strengthening surveillance efforts, advancing diagnostic testing, accelerating research of new treatments, and improving international collaboration. The action plan emphasized reducing unnecessary usage of antibiotics and finding other therapeutic options for infections. Increased funding for these activities was included in the President’s Fiscal Year (FY) 2016 budget.

In response to the detection of mcr-1 in bacteria, the DOD, National Antimicrobial Resistance Monitoring System (NARMS), the U.S. Department of Agriculture’s (USDA) Agricultural Research Service (ARS), the CDC, and the FDA have ramped up their efforts to search for the gene. By fall 2016, the CDC plans to have regional, state, and local labs set up to detect and respond to resistant bacteria. The President’s FY 2017 budget request calls for increased funding for some government agencies for further action.