Lab Matters Summer 2019 - Page 7

FEATURE Arkansas resident Tamika Capone traveled to Tijuana last October for low-cost bariatric surgery and came home with a superbug—VIM-producing carbapenem- resistant Pseudomonas aeruginosa (VIM-CRPA), an organism the US Centers for Disease Control and Prevention (CDC) considers a serious health threat. As quoted in The Washington Post, her Little Rock physician said “I’ve not yet had a patient with zero [treatment] options, but this is as close as I’ve had.” Capone started on a course of colistin— a last-resort antibiotic that can trigger kidney and nerve damage—but stopped treatment after her face and tongue went numb. Now, as The Post reports, she has an infected hole at the abdominal incision site, and it won’t heal and “hurts a lot.” If the highly drug-resistant bacterium enters her bloodstream, the infection could well be fatal. Welcome to a world without antibiotics. Although VIM-CRPA is uncommon in the United States—86 cases were reported to CDC through 2017—Capone’s experience is a preview of what will certainly happen if our antibiotic pharmacopoeia becomes irrelevant. Given the global rise of drug-resistant pathogens over the past few decades, some physicians and scientists warn of a possible antibiotic apocalypse—a scary, post-antibiotic era. Marion Kainer, MD, MPH, an infectious disease expert who directs the Healthcare-associated Infections and Antimicrobial Resistance Program at the Tennessee Department of Health (TDH), said such a fate “is definitely a valid threat.” She said, “We have patients who have untreatable organisms right now. This is not something that’s in the future. Fortunately, in the US it is still relatively rare.” A $160 million CDC effort now aims to keep antibiotic resistance rare. And the keystone of this effort is the Antibiotic Resistance Laboratory Network (AR Lab Network). Established in 2016, the AR Lab Network comprises public health laboratories in 50 states, five cities and Puerto Rico, including seven regional laboratories with advanced testing PublicHealthLabs @APHL APHL.org Arianna Allgood and Erica Terrell read AST plates. Photo: TDH DLS capabilities and the National Tuberculosis Molecular Surveillance Center overseen by the Michigan Department of Health and Human Services. It was the AR Lab Network that generated the data linking Capone to a handful of other CRPA-infected patients who received healthcare in Tijuana. According to The Post, eight of these patients, including Capone, had surgery at the same hospital. Thanks to the AR Lab Network’s scientific work, CDC issued a travel alert with recommendations for patients who had invasive medical procedures in Tijuana and for clinicians who might treat CRPA-infected individuals. The agency also contacted Mexican health authorities, who pinned the outbreak on poor infection control practices and temporarily closed Tijuana’s Grand View Hospital. As of April 20, 2019, the VIM-CRPA outbreak associated with Grand View Hospital appears to be over. But without the AR Lab Network, it might never have been detected. Summer 2019 LAB MATTERS 5