{"id":1074,"date":"2016-06-21T14:53:36","date_gmt":"2016-06-21T14:53:36","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1074"},"modified":"2017-08-21T10:52:38","modified_gmt":"2017-08-21T10:52:38","slug":"primary-care-corner-with-geoffrey-modest-md-e-coli-superbug-is-spreading","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/21\/primary-care-corner-with-geoffrey-modest-md-e-coli-superbug-is-spreading\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: E. Coli Superbug is Spreading"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>Not-so-shockingly, the US government reported the first case of a patient in the US with colistin-resistant E. coli, in a 49 yo Pennsylvania woman with a urinary tract infection. They found a plasmid-mediated piece of DNA which passed along the mcr-1 gene, conferring colistin resistance (see\u00a0<a href=\"http:\/\/www.reuters.com\/article\/us-health-superbug-idUSKCN0YH2KT\">http:\/\/www.reuters.com\/article\/us-health-superbug-idUSKCN0YH2KT<\/a>\u00a0.\u00a0For the case study, see\u00a0doi:10.1128\/AAC.01103-16). This is precisely the issue reported last year in China [see\u00a0<a href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/12\/10\/primary-care-corner-with-geoffrey-modest-md-troubling-microbiome-changes\/\">https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/12\/10\/primary-care-corner-with-geoffrey-modest-md-troubling-microbiome-changes<\/a>\u00a0. This blog looked\u00a0at the initial report from China, noting that China\u00a0is the world&#8217;s largest producer of poultry and pig products and one of the largest veterinary users or colistin (aka polymixin E),\u00a0finding this resistant bug in 16 samples from various sites: sputum, urine, ascitic fluid, bile&#8230;]. Since the Chinese finding, the \u00a0Walter Reed National Military Medical Center has been testing all extended-spectrum b-lactamase-producing E. coli for colistin-resistance.<\/p>\n<p>This current finding and the blog (which goes into detail on the China case) basically make the following points:<\/p>\n<ul>\n<li>Antibiotic resistance is a huge and growing problem: &gt;2 million illnesses blamed on antibiotic resistance in the US with 23,000 annual deaths<\/li>\n<li>Potential for spread of this E. coli, resistant to the last-line big gun colistin, is real, and highlighted by this case in the US 6 months after the report in China. The concern is that the\u00a0ability for\u00a0E. coli to elaborate plasmid-mediated resistance makes it more spreadable than through the\u00a0prior\u00a0identified mechanism of\u00a0chromosomal changes<\/li>\n<li>Part of the issue is us guys: more than 1\/2 of patients admitted to the hospital get an antibiotic, but 30-50% of the time it is considered unnecessary. Blogs below look at the overuse of antibiotics in the outpatient setting as well.<\/li>\n<li>The biggest\u00a0part of the problem\u00a0is use\/remarkable overuse\u00a0of antibiotics in agriculture (as in the colistin case), leading to lots of resistant bugs (see blogs below).<\/li>\n<li>And there is real concern, as per the CDC, that we may be entering a post-effective antibiotic era<\/li>\n<li>Confounding the issue, is the lack of aggressive antibiotic development by drug companies:\u00a0even expensive antibiotics (the $100-200\/pill ones)\u00a0are typically given for short, and therefore less-profitable, courses of treatment. The $$ is in long-term, preferably lifelong need for meds. \u00a0Some of the big drug companies who mostly foreswore against antibiotic drug development have &#8220;signed a declaration calling for new incentives from governments to support investment in development of medicines to fight drug-resistant superbugs&#8221;. Perhaps the hepatitis c drug model will develop: hugely overpriced drugs, which even for only a few months can develop huge profits&#8230;???<\/li>\n<\/ul>\n<p>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 litany of articles\/critiques on antibiotic overprescribing, resistance, and efforts to combat resistance, including a US White House report from last year<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: E. Coli Superbug is Spreading [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/06\/21\/primary-care-corner-with-geoffrey-modest-md-e-coli-superbug-is-spreading\/\">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-1074","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1074","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1074"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1074\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1074"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1074"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1074"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}