January 13, 2017

expert reaction to reports that a US woman died of infection resistant to all antibiotics available in the US

A woman from the US has died from multi-drug resistant Klebsiella pneumoniae. The bacterium was resistant to all antibiotics available in the US.

Prof. Nick Thomson, leader of the bacterial genomics and evolution group at the Wellcome Trust Sanger Institute, said:

“Multi-drug resistant Klebsiella pneumoniae has been recognized by almost all public health organisations, including the World Health Organization as “an urgent threat to human health”. The CDC report highlights the discovery of an isolate that is resistant to all therapeutically relevant antimicrobial treatments. Although this type of bacterium is not common it is not unique either and the current trajectory for this bacterium is to become more and more resistant to treatments. The report highlights international travel and treatment overseas as a feature in the introduction of this pan-resistant isolate into the USA. Since we live in such an interconnected society, this is important because this isolate represents a truly untreatable infection which limits treatment options to principally patient management to prevent ongoing transmission.”

Dr Paul Hoskisson, Reader, University of Strathclyde, said:

“The report indicates that the patient was infected with a strain of Klebsiella pneumonia bacteria that resulted in sepsis and death. The bacterium that caused the infection was resistant to all available antibiotics used to treat systemic infections in the USA, although it was sensitive to an antibiotic called fosfomycin – which is not licensed in the USA for intravenous delivery.

“In several countries in Europe (including the UK) fosfomycin is licensed for intravenous use in cases such as this. 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.

“The report also highlights that appropriate infection control measures, such as testing the drug susceptibility of the bacteria causing the infection, isolation of patients, and good knowledge of previous medical history are vital for slowing the spread of drug resistant infections. Drug resistant infections are a global problem and the movement of people around the world can lead to the dissemination of drug resistant bacteria.”

Prof. Nigel Brown, Microbiology Society spokesperson, said:

“Microbiologists have been concerned for a number of years about the rise of antibiotic resistance in bacteria.  This sad case of a fatal infection acquired overseas, in which the pathogen was resistant to 26 different antibiotics, is a wake-up call for the isolation and development of new classes of antibiotic. There is also a need for international agreements on the use of antibiotics; too many countries allow medically-important antibiotics to be self-prescribed or to be used in agriculture.”

Prof. Laura Piddock, Professor of Microbiology, University of Birmingham, said:

“Despite such multi-drug resistant bacteria being rare, this report is a cautionary tale of the dire outcome for some patients when potentially useful drugs are not available.  In circumstances such as this where doctors are faced with the inability to treat a life threatening infection they need the flexibility to use antibiotics licensed for use in other countries and shown to be active in the laboratory against the patient’s infecting bacterium.”

* https://www.cdc.gov/mmwr/volumes/66/wr/mm6601a7.htm?s_cid=mm6601a7_w

Declared interests

Prof. Laura Piddock: “No conflicts.”

None others received.