Drug-resistant Superbugs in 20 States

Bacteria that are immune to every known antibiotic have been reported by hospitals in more than 20 states. Usually hitting those critically ill, they are fatal in 30 to 60 percent of cases.

The bacteria contain a gene that produces an enzyme which immobilizes antibiotics. The enzyme — Klebsiella pneumoniae carbapenamase or KPC — is even effective against carbapenam antibiotics, the drug used to treat infections that don’t respond to other antibiotics.

“We’ve lost our drug of last resort,” Neil Fishman, director of infection control and epidemiology at the University of Pennsylvania, told USA Today.

Bacteria that are able to survive every modern antibiotic are cropping up in many U.S. hospitals and are spreading outside the USA, public health officials say.
The bugs, reported by hospitals in more than 35 states, typically strike the critically ill and are fatal in 30% to 60% of cases. Israeli doctors are battling an outbreak in Tel Aviv that has been traced to a patient from northern New Jersey, says Neil Fishman, director of infection control and epidemiology at the University of Pennsylvania and president of the Society of Healthcare Epidemiologists.

The bacteria are equipped with a gene that enables them to produce an enzyme that disables antibiotics. The enzyme is called Klebsiella pneumoniae carbapenamase, or KPC. It disables carbapenam antibiotics, last-ditch treatments for infections that don't respond to other drugs.

"We've lost our drug of last resort," Fishman says.

Carbapenam-resistant germs are diagnosed mostly in hospital patients and are not spreading in the community. They're far more common nationwide than bacteria carrying a gene called NDM-1 that made headlines this week, Fishman says.

Those NDM-1 bacteria, named for the city of New Delhi, are rare in the USA and have been found mainly in people who obtain medical treatment in India, Arjun Srinivasan of the U.S. Centers for Disease Control and Prevention (CDC) said Thursday.

Although KPCs are most common in New York and New Jersey, Srinivasan says, "they've now been reported in more than half of the states." A decade ago, only 1% of Klebsiella pneumoniae bacteria reported to CDC by hospitals were carbapenam-resistant. Today, resistance has spread to more than 8% of these bacteria. No one knows precisely how many people have KPC infections because cases aren't routinely reported to the CDC.

"We see a ton of the KPC organisms," says Yoko Furuya, medical director of infection control in New York Presbyterian Hospital. "It started in 2002-2003. They just somehow established themselves in nursing homes and hospitals. We always have some patients, five to 10 at a time, in the hospital with this problem."

Doctors say the bacteria are more worrisome than another well-known superbug, methicillin-resistant Staphylococcus aureus (MRSA), because more drugs are available to treat MRSA, Fishman says. "When MRSA started to develop 15 years ago, the industry started producing antibiotics now coming onto the market," he says. "We're in the same position with KPCs as we were with staph aureus 15 years ago, except that the pharmaceutical industry isn't rushing to produce new drugs."

One of the only drugs that combats these bugs is polymixin, which was all but abandoned years ago because it is so toxic to the kidneys, Fishman says. As a result, he says, prevention is crucial.

In March 2009, the CDC gave hospitals new guidelines for prevention. Among other things, doctors treating any patient diagnosed with carbapenam-resistant infections are advised to wear gowns and gloves to protect themselves and make sure they don't infect other patients.