Researchers have identified a woman in Pennsylvania who is carrying an E. coli bacteria that is resistant to resistant to the powerful antibiotic colistin, which public health authorities called “an alarming development.”
The antibiotic-resistant strain was found last month in the urine of a 49-year-old woman by Defense Department researchers, according to a just-published study in the clinical journal Antimicrobial Agents and Chemotherapy. As reported by several media sources, the authors wrote that the discovery “heralds the emergence of a truly pan-drug resistant bacteria.”
Colistin is the antibiotic of last resort for such superbugs, which the Centers for Disease Control and Prevention estimated can kill up as many as one-half of patients who become infected.
According to The Washington Post, public health officials are interviewing the patient and her family to try to figure out how she contracted the bacteria, reviewing her hospitalizations and other healthcare exposures.
Activists are already gearing up to demand a total ban on antibiotic use in animal agriculture, and truth be told, it’s likely that stricter guidelines on such usage will be actively proposed — not to mention that continued growth of “antibiotic-free” meat and poultry products will push industry in the same direction.
The source of the problem
However, for all the hot air about producers “pumping livestock full of drugs,” the reality is that the larger problem of antibiotic resistance involves human use of the drugs that are now proving to be ineffective against resistant strains of human pathogens.
At the same time as the “superbug” story broke, a major medical study pointed to the real culprit: over-prescription of antibiotics by the nation’s doctors.
According to a major review published in the Journal of the American Medical Association, titled, “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011,” the National Action Plan for Combating Antibiotic-Resistant Bacteria was supposed to reduce “inappropriate outpatient antibiotic use” by one-half by 2020. That didn’t happen.
Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, the authors estimated the annual numbers of ambulatory patient visits that resulted in an oral antibiotic prescription.
“Of the 184,032 sampled [doctor] visits, 12.6% resulted in antibiotic prescriptions,” the report stated, with the most common causes being sinus and ear infections. And here are the important data: “Collectively, acute respiratory conditions per 1,000 population led to 221 antibiotic prescriptions annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. [A]mong all conditions and ages, an estimated 506 antibiotic prescriptions [per 1,000 patient visits] were written annually, and of these, 353 antibiotic prescriptions were estimated to be appropriate.”
So for respiratory conditions — in many cases triggered by the virus that causes common colds — 49% of the antibiotic prescriptions were contraindicated, as physicians love to say. For all patient visits analyzed collectively, 30% of all prescriptions were deemed unnecessary or inappropriate.
Shocking as those numbers might be, the reality is even worse.
In the same issue as JAMA’s antibiotic report, an accompanying editorial noted that the data on inappropriate antibiotic prescriptions are likely lowballed.
That’s because these data don’t include the times antibiotics are prescribed when patients talk to a doctor’s offices over the phone, or when patients seek medical care at urgent care clinics, retail pharmacies and dentists’ offices, nor the prescriptions written by nurse practitioners and physician assistants, who have those privileges in many states.
Given the extensive medical training physicians and healthcare practitioners undergo, why in the world are as many as one-half of all prescriptions provided when they’re really not needed, and won’t do the patient any good?
It’s because of pressure from patients or parents, according to Katherine Fleming-Dutra, a CDC medical epidemiologist and report’s lead author.
“Clinicians are concerned about patient satisfaction and the patient demand for antibiotics,” Fleming-Dutra told The Washington Post, noting that “better communication” by doctors about the dangers of antibiotic overuse could lead to more appropriate prescribing.
Yeah, and greater honesty by politicians could lead to more substantive political debates.
Don’t hold your breath waiting for either development.
The bottom line here is that, as many scientists have cautioned, microbial organisms have tremendous adaptability, and every effort to wipe them out — from prescription drugs to household sanitizers to sub-therapeutic doses given as a prophylactic to livestock — ends up creating a small percentage of resistant “survivors.”
From the day that penicillin was first synthesized in 1928 by Alexander Fleming, humans have been fighting a war against resistant bacteria.
This new superbug is one more battle that had to be waged.
And it won’t be the last.
The opinions expressed in this commentary are solely those of Dan Murphy, a veteran food-industry journalist and commentator.