Let’s Not Forget That Bacteria Kill Too: The Jordanian Edition

What with Ebolanoia at full tilt, we should remember that there are other, equally serious microbiological problems we face. Such as antibiotic resistant bacteria (boldface mine):

“We’ve been noticing an organism, E. coli,” Bakri said. “Many patients come with urinary-tract infections with this organism,” but it doesn’t respond to treatment as it once did. In 2000, E. coli could be treated by the drug ceftriaxone 70 or 80 percent of the time, he estimated. Now its susceptibility is 37 percent, according to Bakri’s data, which also show increasing antibiotic resistance among other bacteria. His findings, based on the hospital’s patients, parallel national trends. “It’s all over the country. Everyone’s complaining of this phenomenon,” he said.

In this new nightmarish world, patients with moderate infections are admitted to hospitals “for very expensive IV antibiotics,” Bakri said, because “they just won’t respond to oral antibiotics.” For virulent infections, even fewer antibiotics are effective, and treatment is more complex. And as health systems deteriorate in surrounding countries, war-injured patients with complicated wounds are flocking to Jordan, the Middle East’s top destination for medical tourism, for treatment, bringing fierce infections with them.

We think that the Middle East is one of the hotspots globally for antibiotic resistance,” said Richard Murphy, an infectious-disease specialist with Doctors Without Borders. We spoke in September during a two-day conference in Amman organized by DWB to jumpstart regional discussion and action on antibiotic resistance. The global medical NGO works all over the world, but it encounters notably high rates of resistance in the Middle East….

To kill these infections, “the antibiotic we use is the last one used in Europe,” said Marc Schakal, DWB’s head of mission for Jordan and Iraq. That antibiotic is imipenem, a broad-spectrum intravenous medication. Although it’s usually a last resort, it’s the drug DWB uses most frequently in Amman because first-line antibiotics aren’t as effective. A full six-week course of imipenem costs $2,600 to $3,000.

When you use carbapenems, the last line in the U.S. and many other countries, as the first treatment option, carbapenem-resistant enterobacteriaceae (‘CRE’; E. coli and relatives) can’t be far behind as a routine phenomenon. What’s really troubling is that routine UTIs (urinary tract infections) need to be treated this way. As best as I can tell from the story, some of these highly-resistant (though not carbapenem-resistant) organisms (‘MDRO’) appear to be ‘walk-in’ UTIs–that is, they’re not healthcare-associated, but ‘out there’ in the general public.

We do not want to live in a world of difficult–or impossible–to treat urinary tract infections. That, by itself, would be a public health disaster. Since most UTI strains are also commensals–they live harmlessly in our guts–that would also mean that the incidence of MRDO clinical infections will increase (e.g., patients’ fauna infect their own bloodstreams after IV insertion).

If we don’t get a handle on this, this could get bad really quickly.

Though I’m sure tax cuts, a Koch-funded PR campaign, and Fox News hysteria would solve the problem….

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2 Responses to Let’s Not Forget That Bacteria Kill Too: The Jordanian Edition

  1. Sean says:

    DWB == MSF?

  2. Potnia Theron says:

    It’s evolution in action, except those are the folks who don’t believe in evolution.

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