Antibiotic-resistant bacteria is public health crisis
Dubbed the “nightmare bacteria,” CRE are on the rise among patients in medical facilities, with many of these organisms resistant to all, or nearly all, antibiotics in existence. Infections caused by CRE are a significant cause of morbidity and mortality around the world. Almost half of patients who get bloodstream infections from CRE bacteria die from the infection.
Rapid CRE testing is the current focus of the CDC’s Antibiotic Resistance Lab Network (AR Lab Network). SHL is a member of this nationwide testing program, which launched in 2016 to rapidly detect antibiotic resistant organisms and respond to outbreaks.
Wade Aldous, director of the laboratory's Disease Control Division, said that “many of these organisms have been associated with health-care facility outbreaks; that's the real concern," adding that one particular CRE organism submitted to SHL "had a novel resistance gene that had never been seen before."
The AR Lab Network testing program was started by the CDC to use public health surveillance to address gaps in detecting resistance to antibiotics and other drugs used to treat infections. As part of the program, a regional laboratory network was established to detect resistant bacterial strains – including CRE – and create a specimen repository to facilitate development and evaluation of diagnostic tests and treatments. Each state received funds to develop infrastructure for public health surveillance and data reporting, and provide incentives for timely reporting of antibiotic resistance and antibiotic use in health care settings.
Antibiotic resistance makes it harder to eliminate infections from patients because existing drugs become less effective, limiting the number of treatment options. “It is something that has been a concern over the last 10 to 15 years," Aldous said.
The CDC notes that antibiotics often have been used inappropriately for so long that the infectious organisms adapt to the drugs designed to kill them. Each year in the United States, approximately 2 million people become infected with antibiotic-resistant bacteria, and at least 23,000 people die as a result.
Aldous said a core group of SHL staff members conduct testing under the AR Lab Network program at the Coralville lab. In certain cases, confirmed isolates are sent to a regional lab in Minnesota for further testing.
SHL also confirms the results with the Iowa facility that sent the isolate, Aldous said, and provides information to the Iowa Department of Public Health, which tracks antimicrobial resistance throughout the state. Hospitals and nursing homes have implemented infection control practices to help limit potential spread.
"We do the testing to say it's there or not," Aldous said of the lab's role in protecting public health in Iowa.
In all of the cases over the past year, including the one involving a previously unseen organism referenced by Aldous, the lab's partners were able to control any outbreaks or potential spread, he added.
These cases are part of the global "One Health" approach to combat antibiotic resistance for human and animal health. On the individual level, patients should follow their physician's directives and not ask for antibiotics when they have a virus, because antibiotics are ineffective against viruses, said Aldous. Regular hand-washing is recommended as another way to help prevent the spread of illness.
"We're really down to our last stand," Aldous said of available drugs. "We want to make sure we use the best drug for the problem."
