{"id":1080,"date":"2016-06-28T14:33:48","date_gmt":"2016-06-28T14:33:48","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1080"},"modified":"2017-08-21T10:52:15","modified_gmt":"2017-08-21T10:52:15","slug":"primary-care-corner-with-geoffrey-modest-md-more-superbugs","status":"publish","type":"post","link":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/28\/primary-care-corner-with-geoffrey-modest-md-more-superbugs\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: More Superbugs"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>Following on the last blogs on colistin-resistant E coli (see <a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/21\/primary-care-corner-with-geoffrey-modest-md-e-coli-superbug-is-spreading\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/21\/primary-care-corner-with-geoffrey-modest-md-e-coli-superbug-is-spreading\/<\/a> and <a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/23\/primary-care-corner-with-geoffrey-modest-md-response-and-further-comments-on-e-coli-superbug-is-spreading\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/23\/primary-care-corner-with-geoffrey-modest-md-response-and-further-comments-on-e-coli-superbug-is-spreading\/<\/a>), Paul Susman sent me the link <a href=\"http:\/\/www.coha.org\/super-bacteria-in-rio-de-janeiros-olympic-arenas\/\">http:\/\/www.coha.org\/super-bacteria-in-rio-de-janeiros-olympic-arenas\/<\/a>\u00a0on the increasing spread of \u00a0<em>Klebsiella pneumoniae<\/em>\u00a0carbapenemase (KPC)-producing bacteria, which has been around for many years. A 2011 article (Arnold RS, South Med J 2011; 104: 45) noted at that time that this difficult-to-treat\u00a0organism, associated with significant morbidity and mortality, had already spread from the northeastern US to most of the world. The CDC commented that 50% of patients infected with this organism will die from it.\u00a0The current link references the upcoming Olympics in Brazil, noting:<\/p>\n<ul>\n<li>KPC is found off the beaches in Rio, where rowing, canoeing and swimming events will take place (i.e., the swimmers, sailors and rowers will be exposed). The source is likely sewage contamination of the waterways<\/li>\n<li>10 samples were taken from five different beaches (Copacabana, Ipanema, Leblon, Botafogo, and Flamengo) and all tested positive for KPC\n<ul>\n<li>Copababana is the site of the triathlon and open swimming competitions, tested positive in 10% of the samples<\/li>\n<li>Botafogo, where sailing and canoeing events are to be held, had 100% of samples positive<\/li>\n<li>Ipanema and Leblon, popular tourist beaches, had 50 and 60% of samples positive<\/li>\n<li>Flamengo beach, where sailing competitions will be held, 90% tested positive<\/li>\n<\/ul>\n<\/li>\n<li>Another study found that\u00a0Guanabara Bay was contaminated, likely because waste from thousands of households and hospitals that\u00a0dump into the streams and rivers that empty there. They note that &#8220;at least 50% of the untreated sewage from Rio de Janeiro is dumped in to Guanabara Bay.<\/li>\n<li>KPC has been found there since 2010. The authorities promised the water would be cleaned. But alas&#8230;.<\/li>\n<li>Another article on Brazil highlights the high rates of methicillin-resistant Staph, vancomycin resistant Enterococci, b-lactamase resistant Klebsiella and E coli, and\u00a0KPC (see Rossi F. Clinical Infectious Diseases 2011; 9: 1138). They attribute the resistance to: overuse of superantibiotics (e.g. colistin\u00a0in the ICUs), high total consumption of antibiotics, availability of over-the-counter antibiotics, inadequate dosing of antibiotics, and poor adherence.<\/li>\n<li>Also Brazil is the world&#8217;s largest beef exporter with the world&#8217;s largest commercial\u00a0cattle herd. The government does regulate antibiotic use (as opposed to the US), though antimicrobial resistance has been found in Brazilian cattle<\/li>\n<\/ul>\n<p>Commentary:<\/p>\n<ul>\n<li>I guess there is more concern about the Olympics than Zika&#8230;<\/li>\n<li>I don&#8217;t mean to single out Brazil by this example.\u00a0But this example yet again reinforces the big picture of potential outbreaks of untreatable infections caused by antibiotic resistance in common microbes. This is a worldwide phenomenon and really does need to be approached in a coherent worldwide manner<\/li>\n<\/ul>\n<ul>\n<li>See\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/category\/antimicrobial-resistance\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/category\/antimicrobial-resistance\/<\/a> for a large number of blogs on this issue, including the US White House special report (see\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/04\/08\/primary-care-corner-with-geoffrey-modest-md-us-effort-to-combat-antibiotic-resistant-bacteria\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/04\/08\/primary-care-corner-with-geoffrey-modest-md-us-effort-to-combat-antibiotic-resistant-bacteria\/<\/a> ),\u00a0as well as the WHO report on antimicrobial resistance (see\u00a0\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/07\/11\/primary-care-corner-with-geoffrey-modest-md-whos-remarkable-scary-report\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/07\/11\/primary-care-corner-with-geoffrey-modest-md-whos-remarkable-scary-report\/<\/a> which documents the remarkably (and scary) presence of really bad resistant microbes all around the world<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: More Superbugs [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/28\/primary-care-corner-with-geoffrey-modest-md-more-superbugs\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-1080","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1080","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1080"}],"version-history":[{"count":0,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1080\/revisions"}],"wp:attachment":[{"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1080"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1080"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1080"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}