Recently, public health officials from Nevada are reporting on a case of a woman who died in Reno in September from an incurable infection. Testing showed the super-bug that had spread throughout her system could fend off 26 different antibiotics. The patient was a female Washoe County resident in her 70s who arrived in the United States in early August 2016 after an extended visit to India. For the full account, see the CDC MMWR “Notes from the Field: Pan-Resistant Klebsiella pneumoniae.”

I deliver presentations on this ongoing, eternal process known as #AntibioticResistance or #AMR quite often. In fact, it’s been one of my primary research topic for over a decade now. Likewise, I have taught clinical laboratory science (CLS) and pre-health profession majors (primarily pre-nursing) and students for over two decades now regarding microbiology and infectious disease topics. And yet, I often feel like so many people, in both healthcare and the general public, still, just don’t get how critically important this topic is to global #publichealth and to our overall healthcare.

Healthcare associated infections, usually called #HAIs, are predicted to have a global financial impact of $100 TRILLION dollars and 10 MILLION deaths by 2050 according to Dr. Margaret Chan from the World Health Organization. But, this is just a statement based on statistics and computer modeling that sometimes ends up on the funeral pyre along with all of the other slogans and themes to try and make an impact on the populace and healthcare environment.

So, let me try to tell you in everyday terms what happened with this Nevada case. An elderly lady in her 70s, like my mom or your mom, grandmother, aunt, neighbor, or other US citizen, had spent quite a bit of time in India. Places like India are where multi-drug-resistant bacteria are more common than they are in the U.S.

However, this is NOT A PROBLEM of “it’s only in 3rd world countries or other foreign places!” NO, it is in YOUR neighborhood and in your hospitals, and in your gyms, classrooms, and other community settings!

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.

This lady (unnamed for privacy) was a Washoe County resident who went into a hospital in Reno for care in mid-August, where it was discovered she was infected with what is called a CRE — carbapenem-resistant enterobacteriaceae. Big Sciency Word there…but it’s just a general name to describe bacteria that commonly live in the gut that have developed resistance to the class of antibiotics called carbapenems — an important last-line of defense used when other antibiotics fail. We see this and other superbugs like Methicillin Resistant Staphylococcus aureus (MRSA) in the U.S. ALL THE TIME. In fact, HAIs kill over 200 per day IN THE UNITED STATES. EVERY DAY, in your state and community. And, it seems like no one notices. Do you notice?

When I talk to my students, family, colleagues, and the press, I like to mention that this is like a jet airliner crashing EVERY SINGLE DAY and no one notices. Or, we notice but don’t act or change our behavior towards antibiotic stewardship. We can and MUST DO BETTER. But, I digress…lets get back to our story of the Nevada case.

So, what does it mean when you hear the phrase or title from the MMWR story “Pan-Resistant – New Delhi Metallo-Beta-Lactamase-Producing Klebsiella pneumoniae?”

WOW…. I wonder if anyone out there knows what that means in real terms.

Recently, many scientists like myself and health communication experts have realized how important #HealthLiteracy and #ScienceCommunication is to the public. Let me try to explain it in common language. The term “pan-resistance” (in a nutshell) basically means that which ever bacteria we are talking about, Klebsiella pneumoniae in this case, has become resistant to ALL (pan) useful antibiotics that typically will kill this organism. There are numerous scientific facts and reasons this occurs including simply that microbes are always changing in response to what is in their environment. You may have heard of the phrase “survival of the fittest” in a biology class during your life. This is basically what is happening with bacteria.

So, without going in to the deep weeds and details, just know that when “we” keep placing bacteria in the environment of different classes/types of antibiotics, the bacteria CAN AND DO mutate to become survivors. The FITTEST of survivors in fact. I like to tell my students and others that “microbes (bacteria in this case, but others as well, like viruses) DO NOT read the textbooks.” Likewise, these microbes DO NOT CARE who you are, where you come from, how rich or poor you are, what you look like, or how much money you spend on healthcare. They simply, mutate (change), resist, and ultimately SURVIVE. And, when they infect us, their purpose is quite simple. They “use us” as a host and if we can’t fight them off on our own (our immune system) or treat them properly with the correct antibiotic to kill them….well, THEY KILL US!

Let that sink in a moment….When antibiotics were 1st utilized after Fleming discovered penicillin in pre-WW2 1928, they truly were “miracle drugs and the magic bullet” because they transformed our ability to treat deadly infections. BUT, what most people in the general public don’t know is that even Fleming, soon after his discovery, reported that bacteria were becoming resistant to penicillin. And, it keeps happening. When “we” are treated with antibiotics for a non-bacterial infection, like the common cold or an allergy, we are all contributing to #AMR little by little. ALL OF US, from the physician who prescribes it without a laboratory confirmed result showing you have a bacterial infection, to “us” begging for the antibiotic even when we don’t have the type of infection the drug will work against, are guilty. When the animal industry continues to use high levels of antibiotics in the animal feed, it contributes to the “Survival of the Fittest” scenario. When we quit taking our antibiotics before we should, or when we “borrow” antibiotics from friends and family members b/c we think we can “self-diagnose” our infection, we are magnifying problem. In some places around the globe, one can simply walk in to a pharmacy or other store and purchase any antibiotic they want, without a laboratory confirmed test to even show that they have an infection. UNACCEPTABLE!

When those in healthcare do not ask patients their travel history to find out, SOONER rather than later, if an infection may be coming in to our healthcare system from places like India or elsewhere, we contribute to the problem because those patients need to be Isolated as soon as possible from the general hospital community. When medical laboratory testing is not utilized to confirm the identification of the bacteria, followed by the critical antibiotic susceptibility testing, which predicts the CORRECT antibiotic(s) to be used, physicians and others are contributing to the problem. We are all to blame and we can and must do better.

Does this make sense? Your grandparents and parents could trust that an antibiotic like penicillin or others could take care of any infections – WE CAN’T.

Everyday, people in places like your neighborhoods, someone is dying from HAIs like MRSA. EVERYDAY! I hope this explanation helps a bit in regards to how the post-antibiotic era has arrived in the United States. It’s not off in a scary, hard to reach jungle or 3rd world country. It’s in your community. Everyday…it Kills. I hope you will join me and follow me @RodneyRohde to learn more.

Check out this recent lecture I was invited to give on this topic regarding #Globalization and #AMR

You can find other videos, podcasts, and articles on this topic and more at my website. #WeSaveLivesEveryday

About The Author

Dr. Rodney E. Rohde (@RodneyRohde) is Professor, Research Dean and Chair of the Clinical Laboratory Science Program (CLS) in the College of Health Professions of Texas State University, where he spends a great deal of time mentoring and coaching students in this sometimes mysterious and vague path. He has been recognized with teaching excellence at both Texas State and Austin Community College. Dr. Rohde’s background is in public health and clinical microbiology, and his PhD dissertation at Texas State was aligned with his clinical background: MRSA knowledge, learning and adaptation. His research focuses on adult education and public health microbiology with respect to rabies virology, oral rabies wildlife vaccination, antibiotic resistant bacteria, and molecular diagnostics/biotechnology. He has published a book on MRSA stories, over 50 research articles, book chapters and abstracts and presented at more than 100 international, national and state conferences. In 2015, Dr. Rohde received the Cardinal Health #urEssential Award as Champion of the CLS Profession, named a Top 20 Professor of CLS and received the Texas State Mariel M. Muir Mentoring Award. Likewise, he was awarded the 2015 and the 2012 Distinguished Author Award and the 2014 and 2007 ASCLS Scientific Research Award for his work with rabies and MRSA, respectively. Learn more about his work here. Dr. Rohde is the current Texas Association for Clinical Laboratory Science (TACLS) President and has been involved in licensure efforts in Texas since 2007.

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