Usually, when I write about about antibiotic resistance, I end with a series of policy recommendations, but this time around, I’ll cut to the chase: we’re fucked. Hard. Sideways with a goddamn chainsaw. I’ll turn it over to Scary Disease Woman (aka Maryn McKenna):
News from the ICAAC meeting: The “Indian superbug” NDM-1 — actually a gene which encodes an enzyme which confers resistance to almost all known antibiotics — has been found for the first time in a pet, somewhere in the United States….
I spoke to Nayak after his ICAAC presentation Tuesday. He said that very little is known about the source of the bacterial samples, including the identity of the family and the cat. “The reason why we don’t know is these were not collected by us, and they were not collected by Dr. Boothe; they were collected by veterinarians,” he said. “So a family comes in, says ‘My cat is not feeling well,’ and the veterinarian collects blood, urine, whatever, and sends them in. There is no history associated with them.”
The timing of the sample is perplexing, he agreed. The isolates were received between 2008 and 2009 from the labs where vets sent them, meaning that the NDM-1 in the unknown cat was collected at the same time as the earliest recognition of the resistance factor in Europe, and at least a year before NDM-1 was perceived in the United States.
He emphasized that it isn’t known whether the cat passed NDM-1 on to its family (or, conversely, whether the family were responsible for giving the bug to their pet). If that happened, it would not be the first time that bacterial traffic between pets and their humans has made one or the other sick. There is a long literature of MRSA passing back and forth between people and their cats and dogs, in some cases making the humans sick and in some cases making the animals very ill… And Nayak’s group actually made the NDM-1 finding while following up two pieces of research they published last year about organisms in pets which had the resistance pattern ESBL — troubling, but still susceptible to carbapenems, and thus one step away from NDM-1.
These organisms are resistant to just about every drug we can throw at them (and in some cases are utterly untreatable).
The best case scenario (as McKenna points out, the epidemiology is very confused), the cat picked it up from a person who has been in the healthcare system. That is, a human was colonized in the hospital, and transferred it to the cat at home. The worst case scenario is that the cat picked it up in the environment, which means that these organisms, in the U.S., are in the environment (either water or asymptomatic colonization of animals, including people).
Would have been nice if, when making that list of questions for the presidential candidates, one of the questions had been about antibiotic resistance (I realize there was a question about emerging diseases, but they really need to be pinned down on this). Because this really could become a major problem.