Single bacterial super-clone behind epidemic of drug-resistant E. coli by 1kiki

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Single bacterial super-clone behind epidemic of drug-resistant E. coli

POSTED BY: 1KIKI
UPDATED: Monday, January 6, 2014 22:04
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Sunday, December 22, 2013 1:35 PM

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

Over the past decade, public health officials noted that E. coli belonging to the ST131 strains family emerged as a major cause of urinary tract and kidney infections. These are the most common bacterial infection in women and elderly. The ST131 bacteria were notable because they had acquired resistance to a class of relatively new antibiotics called fluoroquinolones, which were commonly used to treat urinary tract infections.

More recently, theses pathogens also acquired genes for extended-spectrum beta-lactamase. This change rendered a broad spectrum of antibiotics, including highly-potent penicillin derivatives and cephalosporins, ineffective against these strains of bacteria.

The things you find out … I thought I was pretty up on recent bacteriology and virology trends. For example, I knew that community-acquired MRSA (methicillin resistant staphylococcus aureus) was associated with a recent and highly fatal pneumonia outbreak in the US where five people died within hours of being hospitalized, and only one survived after being in a medically induced coma for weeks. But these people had no contact with each other. What is presumed the problem - was that they were healthy carriers of community-acquired MRSA. Then they caught the flu, their resistance was down, and the bacteria became ascendant and killed nearly all of them. My dad died of >hospital< acquired vancomycin-resistant MRSA – an even nastier version than community acquired - vancomycin being the drug of last resort for hospital-acquired MRSA infections. If it doesn’t work, there are no more alternatives. I knew about those hard-to-treat Acinetobacter baumannii infections found in returning veterans – its multidrug resistance is due to a variety of different mechanisms like its ability to enzymatically break the betalactam rings of penicillin-type antibiotics, it’s protective capsule and its two efflux pumps that excrete aminoglycides in the one case, and tetracycline, chloramphenicol, and various carbapenems in the other (WIKI). I was up on the bacteria, like Klebsiella, that didn’t used to but do now carry the NDM-1 gene – a type of multi-drug resistance gene. It’s a serious problem in Southern California, within a mere five years long-term care facilities went from having zero incidence to having 80% positive-testing carriers and deaths from acute, and untreatable, infection. And I learned recently that that resistance factor can multiply in sewage treatment plants. I already knew about the (now-ancient-history) Jack-in-the-Box E coli O151:H7 infection (having had the infection myself almost 2 decades ago), which is not multi-drug resistant but which carries a particularly nasty set of toxin genes like shiga-like toxin, that can lead to shock, kidney failure, massively hemolyzed red blood cells, and death. But as painful as it was, I also knew that the more recent E coli outbreak in Europe – with disease and death caused by a completely unrelated and totally new set of mechanisms – has an even higher morbidity (disease) and mortality (death) rate. And I knew about the more recent Clostridium difficile diseases caused by super-infection of this pathogen after antibiotic treatment. My mom had it. And when it comes to recent FDA actions, I learned about the more recent FDA moves to voluntarily limit some antibiotics in meat production and to demand proof of effectiveness of antibacterial soaps, though IMO those efforts are way too little, way too late.

But I had NEVER before heard of this bacteria: E coli ST131, a multi-drug resistant form of E coli. Its mention in the article surprised me – What IS this thing? How did I miss it all this time given its importance? So I looked it up. It turns out that this single bacteria is now responsible for the vast majority of UTIs and cases of sepsis in the US. So look at the picture below – which E coli bacteria would you rather be infected with – the one that can be easily killed by a variety of antibiotics, or the one that minimally responds to very few? And which one has spread?

Just. Great.

Antibiotics were a great ride. But at this point, may I suggest we are entering the post-antibiotic era?

Single bacterial super-clone behind epidemic of drug-resistant E. coli

Wed, 12/18/2013 - 3:38pm

This antibiogram compares the resistance of the H30-Rx strain to another strain of E.coli that also infects the urinary tract. Image: Mariya Billig

Virulent, drug-resistant forms of E. coli that have recently spread around the world emerged from a single strain of the bacteria—not many different strains, as has been widely supposed. This is the finding of a study reported in mBio. The strain causes millions of urinary, kidney and bloodstream infections a year. It could have a far greater clinical and economic impact than any other strain of bacteria, including the so-called MRSA superbug.

The research on drug-resistant E.coli was conducted by an international collaborative research team that included Dr. Evgeni V. Sokurenko, Univ. of Washington prof. of microbiology, as well as researchers at Group Health Clinical Laboratory and the Group Health Research Institute in Seattle.

Unlike previously identified superbugs that are usually from multiple strains, these E. coli bacteria belong to just one closely related clone.

“We now know that we are dealing with a single enemy, and that by focusing on this super-clone we can have a substantial impact on this worldwide epidemic,” Sokurenko said.

Over the past decade, public health officials noted that E. coli belonging to the ST131 strains family emerged as a major cause of urinary tract and kidney infections. These are the most common bacterial infection in women and elderly. The ST131 bacteria were notable because they had acquired resistance to a class of relatively new antibiotics called fluoroquinolones, which were commonly used to treat urinary tract infections.

More recently, theses pathogens also acquired genes for extended-spectrum beta-lactamase. This change rendered a broad spectrum of antibiotics, including highly-potent penicillin derivatives and cephalosporins, ineffective against these strains of bacteria. As a result, the infections are increasingly difficult to treat.

These various resistant strains were assumed to have emerged independently around the world in response to their exposure to antibiotics. But this was proven to be incorrect by the laboratories of Sokurenko and two other lead investigators on the study: Lance Price, prof. of environmental and occupational health at the George Washington Univ. School of Public Health and Health Services and an assoc. prof. in the Pathogen Genomics Div. of the Translational Genomics Research Institute in Arizona, and James R. Johnson, prof. of medicine at the Veterans Affairs Medical Center and the Univ. of Minnesota.

In the new study, researchers sequenced the genomes of scores of ST131 bacterial samples collected from patients and animals around the world. Then, using a technique called whole-genome-sequence-based phylogenomic analysis, the researchers constructed a family tree that revealed the bacteria’s evolutionary history. That analysis indicated that almost all ST131 strains responsible for the notoriously resistant infections are very closely related to each other. They arise from a single clone that is termed H30-Rx for its resistance to treatment.

“Astoundingly, we found that all of the resistance could be traced back to a single ancestor,” said Price “This superbug then took off, and now causes lots of drug-resistant infections.”

In addition, the H30-Rx strain is fast-growing and can spread from person to person. It infects both the healthy and infirm, young and old, and is adept at invading the bloodstream, said Sokurenko.

“In some hospitals it is responsible for up to half of E. coli infections. It is the most common single strain causing sepsis, a deadly form of blood infection that kills 20 to 40% of patients who develop it,” he said. “Due to its wide-spread resistance and virulence, the social and economic impact of H30-Rx clone could exceed that of any other bacterial strain known.”

According to James Johnson, the study’s findings may make it possible to develop “better tools to identify, stop or prevent its spread by finding better ways to block the transmission of the superbug, or by finding a diagnostic test that would help doctors identify such an infection early on, before it might have the chance to turn lethal.”

Source: Univ. of Washington

http://www.rdmag.com/news/2013/12/single-bacterial-super-clone-behind-
epidemic-drug-resistant-e-coli?et_cid=3668296&et_rid=366206770&type=headline

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Sunday, December 22, 2013 2:48 PM

SIGNYM

I believe in solving problems, not sharing them.

what I got out of all of that is....

In addition, the H30-Rx strain is fast-growing and can spread from person to person. It infects both the healthy and infirm, young and old, and is adept at invading the bloodstream, said Sokurenko.

So there is a bug that is not only virulent, in the community (not just in hospital), and deadly, it's also untreatable.

Yep. Just. Great. We may have, indeed, entered a post-antibiotic era.

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Monday, December 23, 2013 10:47 AM

BYTEMITE

Quote:
Yep. Just. Great. We may have, indeed, entered a post-antibiotic era.

Basically. But there's non-chemical methods of eliminating bacteria out there that I think will begin to rise to prominence as the anti-biotic resistance grows. Of course, the change-over will only happen once the medical industry has milked the existing obsolete antibiotics for all they're worth and a bunch of people are dead. Which may be all according to some plan or another.

If we can trace this super-resistance back to a single strain, I'd bet money that it was lab created and probably military.

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Monday, December 23, 2013 5:09 PM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

"If we can trace this super-resistance back to a single strain, I'd bet money that it was lab created and probably military."

We part ways here.

I took my first microbiology/ bacteriology class 40+ years ago so I have a long history of continuous knowledge, both in professional life and in the lives of myself and family members. In that time I've seen wave on wave of bacteria show up with previously unknown, completely novel resistance or toxin factors, or both.

When E Coli O157:H7 first hit the media in 1993 (and I had it a couple of weeks before the infamous Jack in the Box incident that almost put the company out of business) it was a mystery where it could have come from. It's only been recently that researchers have found those toxin factors in common soil bacteria, and showed they can be laterally transferred to E Coli.

As a second example of information about this, a recent study showed that for bacteria isolated from the rest of the world for several million years, those bacteria have resistance factors to antibiotics.

http://microbewiki.kenyon.edu/index.php/Lechuguilla_cave_microbiome
"Lechuguilla Cave is a deep and expansive cave in New Mexico, USA. It has roughly 216 km of passageway, and it is 489 m below the surface at its deepest point. The cave and its microbiome have attracted interest from microbiologists because, despite several million years of isolation from the terrestrial environment, bacterial isolates from the cave display widespread resistance to modern clinical antibiotic drugs."

What makes these things more prevalent now is our current practices which allow for more gene transfer between bacteria, and which select for those that are resistant. And may I point out that nearly all of this is due to using antibiotics as a convenient money-maker, larger consequences be damned.

We didn't create the resistance - that's due to a long evolutionary history of chemical warfare between microbes - but we definitely are inflicting this problem on ourselves.

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Monday, December 23, 2013 5:27 PM

BYTEMITE

Quote:
We part ways here.

I meant the E-coli strain itself, not the super resistance. I suppose I should have been clearer.

However, after researching it appears the first ever case was back in 1955 in Switzerland on a dairy farm. It wouldn't be the first time the US tested a pathogen on a foreign target, but the story appears consistent with a genuine outbreak.

So I lose that bet. Normally it's a pretty safe bet though.

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Monday, December 23, 2013 5:29 PM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

I'm probably not quite as cynical as you about this, but in general we are in the same quadrant.

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Monday, December 30, 2013 9:28 PM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

This is just more information along the same vein. What I find astounding is the graphic that came with the article. As for the problem itself - we could probably - if we REALLY put our minds to it - eventually come up with a solution. We could focus research on new antibiotics, bacterial vaccines, treatments and general prevention techniques. The more general problem is this: could we change our economic and regulatory systems enough to keep this from happening all over again.

http://www.laboratoryequipment.com/news/2013/12/researcher-antibiotics
-agriculture-creating-public-health-crisis?et_cid=3681279&et_rid=366206770&type=headline

Researcher: Antibiotics in Agriculture Creating Public Health Crisis

Fri, 12/27/2013 - 8:35am

Univ. of Calgary

This image shows estimated antibiotic use in the United States. Data are shown as approximate numbers of kilograms of antibiotics used per year. Graphic by The New England Journal of Medicine. Credit: The New England Journal of Medicine

This image shows estimated antibiotic use in the United States. Data are shown as approximate numbers of kilograms of antibiotics used per year. Graphic by The New England Journal of Medicine.

Credit: The New England Journal of Medicine

Citing an overabundance in the use of antibiotics by the agriculture and aquaculture industries that poses a threat to public health, economics professor Aidan Hollis has proposed a solution in the form of user fees on the non-human use of antibiotics.

In a newly released paper published in the New England Journal of Medicine, Hollis and co-author Ziana Ahmed state that in the United States 80 percent of the antibiotics in the country are consumed in agriculture and aquaculture for the purpose of increasing food production.

This flood of antibiotics released into the environment – sprayed on fruit trees and fed to the likes of livestock, poultry and salmon, among other uses – has led bacteria to evolve, Hollis writes. Mounting evidence cited in the journal shows resistant pathogens are emerging in the wake of this veritable flood of antibiotics – resulting in an increase in bacteria that is immune to available treatments.

If the problem is left unchecked, this will create a health crisis on a global scale, Hollis says. Hollis suggest that the predicament could be greatly alleviated by imposing a user fee on the non-human uses of antibiotics, similar to the way in which logging companies pay stumpage fees and oil companies pay royalties.

"Modern medicine relies on antibiotics to kill off bacterial infections," explains Hollis. "This is incredibly important. Without effective antibiotics, any surgery – even minor ones – will become extremely risky. Cancer therapies, similarly, are dependent on the availability of effective antimicrobials. Ordinary infections will kill otherwise healthy people."

Bacteria that can effectively resist antibiotics will thrive, Hollis adds, reproducing rapidly and spreading in various ways. "It's not just the food we eat," he says. "Bacteria is spread in the environment; it might wind up on a doorknob. You walk away with the bacteria on you and you share it with the next person you come into contact with. If you become infected with resistant bacteria, antibiotics won't provide any relief."

While the vast majority of antibiotic use has gone towards increasing productivity in agriculture, Hollis asserts that most of these applications are of "low value." "It's about increasing the efficiency of food so you can reduce the amount of grain you feed the cattle," says Hollis. "It's about giving antibiotics to baby chicks because it reduces the likelihood that they're going to get sick when you cram them together in unsanitary conditions. "These methods are obviously profitable to the farmers, but that doesn't mean it's generating a huge benefit. In fact, the profitability is usually quite marginal. "The real value of antibiotics is saving people from dying. Everything else is trivial."

While banning the use of antibiotics in food production is challenging, establishing a user fee makes good sense, according to Hollis. Such a practice would deter the low-value use of antibiotics, with higher costs encouraging farmers to improve their animal management methods and to adopt better substitutes for the drugs, such as vaccinations. Hollis also suggests that an international treaty could ideally be imposed. "Resistant bacteria do not respect national borders," he says. He adds that such a treaty might have a fair chance of attaining international compliance, as governments tend to be motivated by revenue collection. Hollis notes that in the U.S., a move has been made to control the non-human use of antibiotics, with the FDA recently seeking voluntary limits on the use of antibiotics for animal growth promotion on farms. He asks: "Is the Canadian government going to take any action to control the use of antibiotics for food production purposes? Health Canada is trying to monitor the use of antibiotics, but has virtually no control over use."

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Tuesday, December 31, 2013 4:02 AM

SHINYGOODGUY

I remember reading, some years back, about the advent of the anti-bacterial soaps and cleaners (corporate America always looking for the bigger, better deal).

Those in the know warned of exposing bacteria to a totally clean world and how they would adapt and change to their environment. Scientists insisted that soap and water (while washing hands and the like) was sufficient to combat germs and bacteria. It seems their warnings and subsequent findings have come to fruition.

SGG

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Sunday, January 5, 2014 11:50 PM

1KIKI

Goodbye, kind world (George Monbiot) - In common with all those generations which have contemplated catastrophe, we appear to be incapable of understanding what confronts us.

I'm not sure there are too many good ways to die - but pneumonia has got to be among the worst. Both parents died ultimately from untreatable pneumonia, in my dad's case hospital-acquired vancomycin resistant MRSA, in my mom's case the causative agent was undetermined. Imagine being unable to ignore the feeling that you need to breathe more, and unable to actually do it. With every agonized breath they suffocated to death, not over minutes, or hours, but days. They were only small personal tragedies caused by antibiotic resistant bacteria.

But multiply that by tens of thousands: "Every year, more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result ..." http://www.cdc.gov/media/releases/2013/p0916-untreatable.html

The reason WHY it's become a problem? Because too many people think of antibiotics as a shortcut to profits, and because there's no effective regulation that requires products are proved safe in the grand scheme of things. So society - that's us - pays the price for private profit, while regulation lumbers along at catch-up that it never quite achieves.

Don't mind me. This is a topic I feel extremely bitter about. I'm just venting.

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Monday, January 6, 2014 10:04 PM

CHRISISALL

Quote:
I'm just venting.

Justifiably.

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