Primary Care Corner with Geoffrey Modest MD: More Superbugs

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By Dr. Geoffrey Modest

Following on the last blogs on colistin-resistant E coli (see https://stg-blogs.bmj.com/bmjebmspotlight/2016/06/21/primary-care-corner-with-geoffrey-modest-md-e-coli-superbug-is-spreading/ and 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/), Paul Susman sent me the link http://www.coha.org/super-bacteria-in-rio-de-janeiros-olympic-arenas/ on the increasing spread of  Klebsiella pneumoniae carbapenemase (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 organism, 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. The current link references the upcoming Olympics in Brazil, noting:

  • 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
  • 10 samples were taken from five different beaches (Copacabana, Ipanema, Leblon, Botafogo, and Flamengo) and all tested positive for KPC
    • Copababana is the site of the triathlon and open swimming competitions, tested positive in 10% of the samples
    • Botafogo, where sailing and canoeing events are to be held, had 100% of samples positive
    • Ipanema and Leblon, popular tourist beaches, had 50 and 60% of samples positive
    • Flamengo beach, where sailing competitions will be held, 90% tested positive
  • Another study found that Guanabara Bay was contaminated, likely because waste from thousands of households and hospitals that dump into the streams and rivers that empty there. They note that “at least 50% of the untreated sewage from Rio de Janeiro is dumped in to Guanabara Bay.
  • KPC has been found there since 2010. The authorities promised the water would be cleaned. But alas….
  • Another article on Brazil highlights the high rates of methicillin-resistant Staph, vancomycin resistant Enterococci, b-lactamase resistant Klebsiella and E coli, and KPC (see Rossi F. Clinical Infectious Diseases 2011; 9: 1138). They attribute the resistance to: overuse of superantibiotics (e.g. colistin in the ICUs), high total consumption of antibiotics, availability of over-the-counter antibiotics, inadequate dosing of antibiotics, and poor adherence.
  • Also Brazil is the world’s largest beef exporter with the world’s largest commercial cattle herd. The government does regulate antibiotic use (as opposed to the US), though antimicrobial resistance has been found in Brazilian cattle

Commentary:

  • I guess there is more concern about the Olympics than Zika…
  • I don’t mean to single out Brazil by this example. But 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
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