Close encounter with a superbug
Some time ago, one of my colleagues and I stared at the test results of a patient in awe. It's not uncommon for us to work up drug-resistant organisms. What was unusual was the specimen we had to conduct repeat analysis on. It wasn't my first time seeing a super resistant organism, but it was always a special occasional.
A 30-year-old female patient had a persistent urinary tract infection (UTI) caused by E. coli. Patient did not have recent travel history outside of the state.
First round of analysis found the organism to be multi-drug resistant via MicroScan. Repeat analysis through BD Phoenix and other turbidimetric method displayed the same results.
Not only was it a multi-drug resistant organism (MDRO), it had extreme resistance. The bacteria was resistant to Avycaz, Vabomere, and Zerbaxa!
Why is that significant?
The drugs mentioned are "combination drugs" designed to take care of resistant bacteria. In this case, ones that produce beta-lactamase and even carbapenemase. The drugs work by inhibiting enzyme activities in conjunction with antibiotics.
Without going into insane details about their mechanisms, here's an easier primer: https://www.idstewardship.com/comparison-avycaz-vabomere-zerbaxa/.
By this point, you could only fear the worst for the patient. If left to persist, it was only a matter of time it could become septic and fatal. When all the drugs fail, the only hope is a miracle from your immune system.
When the drugs don't work
All was not lost for our patient. There were still a few drugs left available to treat her ailment.
The physician only had choices between nitrofurantoin, tigecycline, and Zosyn. It's interesting to note that these drugs are much older than the combination drugs. The MDRO had most likely never encountered them before. They are usually not on the first choice list where I work.
With an organism this resistant, the medical director demanded molecular tests. What we found was both fascinating and disturbing. It would appear the E. coli had the New Delhi metallo-β-lactamase variant 1 gene (NDM-1). This is an emerging infectious disease phenomenon.
The CDC actually has entries for these nasty organisms. One of such is here: https://wwwnc.cdc.gov/eid/article/21/6/14-1578_article
As you can see, it came from the Indian subcontinent. In context of the patient, it didn't quite make sense. The patient did not have travel history to that area. In fact, she's not even of the ethnicity from the region.
In the end
I never knew what became of the patient or her treatment. I hope things worked out for her. While the world is battling Covid, they don't realize there are much scarier fiends in the abyss. And, they are getting stronger as time passes.
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Pretty cool though, these other viruses are like mob bosses chilling building letting the tiny gangs have their war then boom we finally get to fight zombies.
I personally fear these drug resistant bacteria more than Covid.
Yeah I think they are quite nasty. My boss went to the hospital I think for a knee thing just before the whole covid crap and he came out with something affecting his lungs and is diabetic although the doc did not know what he had he had to give him something to fight it but then that would make him worse due to diabetics then fix the diabetics but that would make the lung situation worse again because the virus is obviously still present. He basically had early covid symptoms but no one ever figured it out and it took him about 6 months to regain full energy and being able to breath proper. He says it is from someone that was in a room across for some reason no one was ever allowed in except staff assigned. Hospitals do breed their fair share of mutants, and maybe that girl did not travel but had an extensive medical history in general.
Yeah, nosocomial infections are a thing.
In this patient's case, I doubt it was because we did not have an "outbreak" in our inpatient area.
If anything, the state should be looking around where she's living.
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It can be scary at times.
This was very helpful information and interesting to read. I didn't know that drug resistant bacterias are a thing. Nice excavations.
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It's just evolution.
is why I could never do your job!
The issue of drug resistant strains of bacteria seems to have been buried under the avalanche of Covid which is scary, as is the fact I can still buy things like Amoxycillin over the counter by the bucket load in places like Thailand if I so desired, although not as scary as it is to see modern combination treatments failing as in this case.
People will only learn when it's too late.
It's pretty scary to think that there is a point when evolution outpaces our manufactured drugs unless we do something more.
Reading your post I think of the other diseases, everyone gets sick with covid, this patient, for example, according to your post, has a disease that is not simple, you say that you do not know what happened to her, she does not have covid, she has another disease, the point is , the other diseases are also present , and they are not so important , conclusion I agree with you , there are more diseases than just covid 19
Why should I be afraid?
I keep hearing it is dangerous, but the more I read about it the less I think there is almost nothing I can do as an individual who isn't a professional in any of the fields which are tackling this problem. I do the obvious stuff like not eating handfuls of dirt or antibiotics, cleaning myself, not needlessly burdening the system and helping to prevent germs from spreading, etc.
Never said you had to be afraid.
Just pointing out there are worse things than Covid that seems to be triggering a lot of people right now.
Covid? I just shut up and try my best to do what the government tells me.
But I want to be afraid of something else. It's refreshing.
Hey, the topic of super drug-resistant bacteria is really interesting stuff and the name "superbugs" reminded me of a video I saw a long time ago about Bacteriophages.
What do you think about bacteriophages, do you think they can really be a good ally to fight this type of bacteria, or are there also other alternatives?
Anyway, this is the video i'm talking about:
Some of the Corynebacterium is believed to have acquired the ability to cause diphtheria-like diseases because they got infected by bacteriophages.
Life can go either way.
lol so basically we can be screwed if life decides that.
Life is fun.
It's definitely something scientists are exploring right now.
30 year old female with UTI and no trvale history. Would probably pry on her partner(s) while I'm just poking for sources. It's going to take another year or two before our own mole lab could process these as most resources are shifted to covid testing.
I rarely see some organisms grown in culture having multiple resistant tags but we can't test this further for molecular levels without sending it out to the national centers. Would be nice as a learning experience if we had one.
We had to send it to a reference lab to find out it had the NDM-1.
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Too bad you don't have the answers to the many questions this blog triggered in me. I just hope that things went better for the woman too... Moreover, as you added at the end of this post, I also hope that people will notice nasty stuff lives outside, beyond COVID (I however have big doubts about this).
The “right” answers are above my pay grade.
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You did not read the article of a patient who went to thailand and got gonorrhea! When he went to the hospital, the specialists detected that this strain was resistant to all the drugs on the market...According to it was the most resistant thing they had seen in a sexually transmitted disease, and in summary of the article I remember that he said that the day that humanity will encounter a disease with 99% mortality resistant to everything... There we would become extinct... Shit!
This is the third time I've encountered a superbug. They'll evolve, just like we do.
We likely won't become extinct, just like the Black Death couldn't do it. Life will find a way.
Okay! What I learned from the (plague inc) game that I was very addicted to is that we are easy to annihilate xD xD you should play it 😎😂
Done it before. It's all right.
https://www.google.com/amp/s/www.bbc.com/mundo/noticias-43578888.amp this is the article
Oh this is not awesome to read while my gf has a uti. I’ll be trying my hardest to avoid mention it to her.
Haha, she’ll be fine.
AND THEN @adamada’s comment!!! Good point, bad timing for me… all unnerving. My greatest solstice I knowing that she probably got it from the cat litter clay she mopped/LAMINATED the bathroom floor with.
Mop like that, let it sit for too long, walk around barefoot, and then bring those tainted feet into bed… super bug.
If it’s not the cause then I would guess that taking too many baths without rinsing off the bath water. I’ve also heard of women getting uti from bath salts.
This may be tmi, but sometimes, having better sexual hygiene also help with UTI. That goes for both of you really.
My tmi… thanks for listening. Your tmi… nah your correct and sexual hygiene is a phrase not said enough.