I’ve discussed before the serious problem of carbapenem-resistant enterobacteriaceae (‘CRE’): these are common disease-causing bacteria that have evolved resistance to all penicillin derivatives, and usually are resistant to all other commonly used antibiotics* (and in some cases, every antibiotic). So I have two disturbing things to report.
The first is that I hear from colleagues who have visited China that carbapenems are being advertised to farmers (for agricultural use). I’ve looked online, and there are quite a few agricultural suppliers selling carbapenems (mostly meropenem). The good news is that the appropriate Chinese ministries are trying to get a handle on this, although it’s unclear if they’ll be successful. Because what could possibly go wrong with creating a widespread selective environment favoring CREs? (Got cefquinome?) Answer for those of you in the slow public policy group: everything.
Second–this chart from The Center for Disease Dynamics, Economics & Policy:
I would argue that this underestimates the scope of the problem. The data don’t include faropenem use. While faropenem is somewhat different chemically from meropenem and imipenem, the genes involved in carbapenem resistance protect bacteria from faropenem. Faropenem use will also lead to an increase in CREs.
I have this sinking feeling that, as is usually the case with antibiotic resistance, we are simply cataloging the apocalypse. Leaving aside the dire and legitimate concerns of untreatable life-threatening infections, CREs include E. coli and Klebsiella, the two most common urinary tract infection organisms**. Do you want to live in a world where a (hopefully) small percentage of UTIs can’t be treated? Seems like it might be an important political issue.
*Colistin often works, but it can cause renal failure, and resistance evolves rapidly. Tigecycline can work but isn’t very effective in bloodstream infections.
**The ‘E’ in CRE stands for Enterobacteriaceae, the family that includes E. coli, Klebsiella, and Salmonella, among others.