Researchers have found bacteria resistant to the antibiotic of last resort in a sample from a second patient in the United States, according to a study published Monday. The patient had surgery at a New York hospital last year, researchers said.
The news comes after researchers reported in late May that a patient in Pennsylvania carried a strain of E. coli bacteria that was resistant to the antibiotic colistin, the antibiotic that doctors use to treat patients who have infections that don't respond to other drugs.
In both cases, the bacteria carried a gene, known as mcr-1, that allows the organism to withstand colistin. The Pennsylvania case was the first time this colistin-resistance gene had shown up in this country after it was first identified in China last fall. Health officials and infectious disease experts around the world have sounded the alarm because the gene has since been found in more than two dozen countries around the world, in animals and people.
The latest research, published in Antimicrobial Agents and Chemotherapy, a journal of the American Society for Microbiology, comes at a time when scientists have been intensifying their efforts to find threats to their antibiotic arsenal.
Last week, scientists reported the discovery of another gene that makes bacteria resistant to colistin. The gene, called mcr-2, was found in E. coli bacteria from pigs in Belgium and is similar to mcr-1. On Monday, Italian investigators said they discovered a variant of the mcr-1 gene in a rectal swab from a child hospitalized with leukemia.
Experts tracking infectious disease say they're not surprised that more genes and variants are showing up as researchers intensify their search for them by retrospectively searching collections of organisms that date back decades. That's how researchers found the most recent discovery in the New York patient.
Researchers at JMI Laboratories in North Liberty, Iowa tested more than 13,000 strains of E. coli bacteria and more than 7,000 of Klebsiella pneumoniae they had collected from hospitals in Asia, Latin America, Europe and North America in 2015. They found 390, or nearly 2 percent, were resistant to colistin, and 19 tested positive for mcr-1.
The 19 included a strain of E. coli originally recovered from the New York patient in 2015, said Mariana Castanheira, director of molecular and microbiology at JMI. "I know the patient went through surgery and the isolate was deemed the cause of the infection," she said in a recent interview. She declined to identify the hospital, which she said was investigating the case.
The biggest fear of public health officials and experts is that is that the gene will spread to bacteria that are now susceptible only to colistin. In almost all cases involving mcr-1, the gene is carried on a plasmid, a mobile piece of DNA that easily can transfer the gene to other bacteria. That would result in a kind of super-superbug, invincible to every life-saving antibiotic available.
JMI researchers said the strains that tested positive for mcr-1 so far were still susceptible to several commonly used antibiotics, including carbapenems. Researchers suspect the gene is on a plasmid, and are working with other labs to confirm that.
Testing for mcr-1 is not something that most hospitals in the United States do because resistance to colistin is still relatively rare. In addition, the test requires more molecular biology than hospitals are equipped to do, said Mike Bell, deputy director of health care promotion at the Centers for Disease Control and Prevention.
The CDC is planning to establish seven regional laboratories this fall that will have the capacity to do better and faster testing for a broad range of antimicrobial resistance.
Lance Price, director of the Antibiotic Resistance Action Center and a George Washington University professor, said the United States and countries around the world need to push for a global effort to control antibiotic use in human medicine and in livestock production. Colistin is not used in livestock in the United States but it is widely used to promote livestock growth in many other countries.