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f it sometimes seems like the idea of antibiotic resistance, though unsettling, is more theoretical than real, please read on.

Public health officials from Nevada are reporting on a case of a woman who died in Reno in September from an incurable infection. Testing showed the superbug that had spread throughout her system could fend off 26 different antibiotics.

“It was tested against everything that’s available in the United States … and was not effective,” said Dr. Alexander Kallen, a medical officer in the Centers for Disease Control and Prevention’s division of health care quality promotion.

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Although this isn’t the first time someone in the US has been infected with pan-resistant bacteria, at this point, it is not common. It is, however, alarming.

“I think this is the harbinger of future badness to come,” said Dr. James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center.

Other scientists are saying this case is yet another sign that researchers and governments need to take antibiotic resistance seriously. It was reported Thursday in Morbidity and Mortality Weekly Report, a journal published by the CDC.

The authors of the report note this case underscores the need for hospitals to ask incoming patients about foreign travel and also about whether they had recently been hospitalized elsewhere.

The case involved a woman who had spent considerable time in India, where multi-drug-resistant bacteria are more common than they are in the US. She had broken her right femur — the big bone in the thigh — while in India a couple of years back. She later developed a bone infection in her femur and her hip and was hospitalized a number of times in India in the two years that followed. Her last admission to a hospital in India was in June of last year.

The unnamed woman — described as a resident of Washoe County who was in her 70s — went into hospital in Reno for care in mid-August, where it was discovered she was infected with what is called a CRE — carbapenem-resistant enterobacteriaceae. That’s a general name to describe bacteria that commonly live in the gut that have developed resistance to the class of antibiotics called carbapenems — an important last-line of defense used when other antibiotics fail. CDC Director Dr. Tom Frieden has called CREs “nightmare bacteria” because of the danger they pose for spreading antibiotic resistance.

The superbugs are growing in number and strength. Hyacinth Empinado/STAT

In the woman’s case, the specific bacteria attacking her was called Klebsiella pneumoniae, a bug that often causes of urinary tract infections.

Testing at the hospital showed resistance to 14 drugs — all the drug options the hospital had, said Lei Chen, a senior epidemiologist with Washoe County Health District and an author of the report. “It was my first time to see a [resistance] pattern in our area,” she said.

A sample was sent to the CDC in Atlanta for further testing, which revealed that nothing available to US doctors would have cured this infection. Kallen admitted people in this field experience a sinking feeling when they’re faced with a superbug like this one.

“I think it’s concerning. We have relied for so long on just newer and newer antibiotics. But obviously the bugs can often [develop resistance] faster than we can make new ones,” he said.

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Doctors and scientists who track the spread of antibiotic resistance — the rapidly proliferating swarm superbugs — see this case as a big red flag.

“If we’re waiting for some sort of major signal that we need to attack this internationally, we need an aggressive program, both domestically and internationally to attack this problem, here’s one more signal that we need to do that,” said Lance Price, who heads the Antibiotic Resistance Action Center at George Washington University.

There is international recognition of the threat, which an expert report published last year warned could kill 10 million a year by 2050 if left unchecked. In September, the UN General Assembly held a high-level meeting on antibiotic resistance, only the fourth time the body had addressed a health issue.

The woman in Nevada was cared for in isolation; the staff who treated her used infection control precautions to prevent spread of the superbug in the hospital. Chen and Randall Todd, a health department colleague, told STAT testing was done to look for additional infections, but so far none have been detected.

Johnson said it’s likely, though, that other people in the US are carrying similar bacteria in their guts and could become sick at some point. “It’s possible that this is the only person in the US and she had the bad luck to go to India, pick up the bad bug, come back and here it is, we found her and now that she’s dead, it’s gone from the US. That is highly improbable,” he said.

“People have asked me many times ‘How scared should we be?’ … ‘How close are we to the edge of the cliff?’ And I tell them: We’re already falling off the cliff,” Johnson said. “It’s happening. It’s just happening — so far — on a relatively small scale and mostly far away from us. People that we don’t see … so it doesn’t have the same emotional impact.’’

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  • First, the woman was treated in unspecified conditions in India for two years. Second, she did not receive all the available antibiotics, only the ones approved by the FDA. Better to let her die of an infection than from a last-ditch attempt with a drug available elsewhere? The FDA might as well ban other last-ditch attempts like chemotherapy that also kill many patients by that idiotic philosophy.

  • It sounds very ominous, except when you look at the projected #s. I mean 10 million a year? That’s nothing when we will have a population of 8-9 billion people. So if left unaddressed, the worst case scenario is .001% of the population will die every year? That’s not really that alarming.

    • First, 10 million per year is 0.1% of 9 billion, not 0.001% as you said.

      Second, it is actually very alarming when you consider that the current death rate is about 8 deaths per year per 1000 people, or 0.8% of people per year. This means that, if their projection is correct, as many as 1 in 9 deaths could be due to antibiotic resistance (assuming nothing else changes). That’s a lot.

  • Giving a sick 70 year old woman, 14 different kinds of the most powerful and toxic antibiotics available, in such a short period of time, would have killed a healthy 70 year old as well.

  • What happens when a superbug that is in the urinary tract or the bowl that ends up in a sewage system that has no means to deal with it and it ends up spreading to water sources that cannot effectually remove these superbugs. The only way to stop the progression in the drinking water supply is by distillation of the water that is almost impossible on a large scale and the distillation equipment needs cleaning often which entails clean room practices to prevent distribution of the superbugs by contamination.

    • This superbug is resistant to antibiotics, not chlorine or ozone. Cryptosporidium is far harder to kill in sewage than any bacteria. The problem is killing it once it is inside your body, not with killing it outside the body. Furthermore, if you have sewage contaminating your drinking water, you will be dead long before you ever encounter this bug.

  • I wonder why antibiotic resistant superbugs would be more prevalent in India, as mentioned in this article,where antibiotic use is likely much less than in America?

    • However, instead of people in the USA having access to cheap antibiotics, we feed billions of farm animals tons of the best antibiotics we have. You want to talk of making drugs resistant because a few million take them or just make Americans pay a few 100 dollars to see a doctor for an antibiotic? It is pharmaceutical industry garbage they restrict such meds in America to humans to avoid resistance when they feed 1000’s of TONS of these to cows pigs and chicken in America every year.

  • Glad the hospitals I worked in started Antimicrobial Stewardship back in 1984 and continued forward. We identified the first cases of plasmid mediated resistance to quinolones in 1989. In spite of industry over promoting their antibiotics and suggesting certain bacteria and fungus were more frequent in patients than what we saw in practice, we maintained our sensitivity patterns to take care of our patients and that included a large teaching level 1 trauma center with a burn unit. We knew 5,10,15 years down the road we could run out of treatment options. Bacteria are like people, they adjust to the environment you expose them to and they develop mechanisms to survive. We used to use this statement, to educate the community.
    In the patient mentioned, that I don’t have all the information on, it is possible the organism colonized and may not have created symptoms, until something caused the situation. I was involved with Investigational Drug Studies with anti-infectives over the years and looking at Adverse Drug Events, etc. and can tell you that some countries had worse issues than ours. So, it is possible that some resistant organisms can be brought into the US.

  • I recommend people read some history before pontificating on the benefits of going “back to the basics as God intended.” As just one example, before modern sewage systems (thanks to science and engineering), people lived in their own filth in London and died in the thousands due to cholera outbreaks from sewage infected water supplies. “Going back to basics” would in large part still depend on modern medicine and science. Why idolize a history of mankind that doesn’t exist?

  • Difficult to accept that the bacteria she acquired from India remained her body for a while without causing any problems and one day those bacteria alone sprung up to multiply and cause death!

    • Not difficult, very possible, since a artificial stimuli from ingestion of antibiotics could kill other bacteria, and make it possible for this bacteria to have no competition and multiply to large numbers where it’s toxins become lethal.

  • That’s a bunch of racist bull crap. I live in Nevada also and I have no problem with people m9ving here from other countries. Also didn’t it say she was an American citizen who got sick while visiting India?

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