Issue link: https://beckershealthcare.uberflip.com/i/802380
21 ANTIBIOTIC RESISTANCE & STEWARDSHIP Nevada Woman Dies of Superbug Resistant to All 26 Available Antibiotics By Brian Zimmerman A woman in Reno, Nev., died of a bacterial infection resistant to all antibiotics available in the U.S. in early September 2016. e case was publicly reported for the first time in January in a Morbidity and Mortality Weekly Report from the CDC. e unidentified woman was in her seven- ties and had previously traveled to India — where multidrug-resistant bacteria are more common — for an extended period of time. In India, the woman was hospitalized mul- tiple times over two years for a right femur fracture and subsequent bone infection of the right femur and hip. Aer being admitted to an acute care hospital in Reno Aug. 18, cli- nicians detected an infection with carbapen- em-resistant Enterobacteriaceae — specifical- ly Klebsiella pneumoniae — resistant to all 26 different antibiotics available in the U.S. e patient was cared for in isolation and tests on patients in the same unit did not find addi- tional CRE, according to the CDC report. e report's authors concluded that U.S. healthcare facilities should obtain a patient's history regarding exposures to healthcare en- vironments outside of the region during pa- tient screening and consider testing for CRE when a patient reports healthcare exposure in an area with higher rates of CRE activity. "I think this is the harbinger of future bad- ness to come," James Johnson, MD, a pro- fessor of infectious diseases medicine at the University of Minnesota in Minneapolis, told STAT when asked about the case. Dr. Johnson said it's likely others in the U.S. are harboring these bacteria in their guts and could become sick at some point in the fu- ture. On the dangers of the growing threat of anti- biotic resistance, Dr. Johnson told STAT: "People have asked me many times 'How scared should we be?' ... 'How close are we to the edge of the cliff ?' And I tell them: We're already falling off the cliff. It's happening. It's just happening — so far — on a relatively small scale and mostly far away from us ... so it doesn't have the same emotional impact." n 2 Techniques to Reduce Antibiotic Resistance Prove Ineffective in New Study By Brian Zimmerman T wo methods used to theoretically hinder the evolu- tion of antibiotic resistance proved ineffective in a study published in January in the journal of Molecular Biology and Evolution. For the study, clinical scientists and mathematicians reviewed accumulated data on clinical trials to determine the efficacy of mixing — a random assignment of appropriate-class an- tibiotics — and cycling — a process akin to crop rotation in which certain antibiotics are withheld for a period of time. Analysis of the data, which amounted to more than 4 million patient days of treatment, showed no significant correlation between the prevention strategies and the prevalence of an- tibiotic resistance. Researchers recommended both patient-specific and patho- gen-specific assessments to optimize antibiotic use. "For example, in the doomsday scenario that multidrug re- sistance is endemic and present in every infection before the patient begins treatment, it matters little which treatment patients are given," said study co-author Rafael Pena-Miller, PhD, an assistant professor in microbial systems biology at UNAM Morelos in Mexico. "But before that stark situation arises, targeting appropriate treatment at as many individu- als as possible outperforms both mixing and cycling." n