There is a public health crisis too small for the naked eye to see: antibiotic resistance. It affects at least 2 million people in the U.S. each year.
A study published in the Antimicrobial Agents and Chemotherapy Journal by Timothy Johnson, Ph.D., associate professor in the College of Veterinary Medicine, in collaboration with the Minnesota Department of Health, has identified a new strain of antibiotic resistant bacteria that has spread throughout North Dakota and Minnesota, presumably by both patients and healthy, asymptomatic people.
The bacterium, called Enterobacter cloacae (E. cloacae), was found to spread within healthcare facilities and to different healthcare facilities across the region. Johnson believes the bacterium spreads by patients, healthy healthcare workers and those visiting patients.
Because these healthy and asymptomatic people don’t realize they are carrying the bacterium, it spreads easily across geographical regions.
“If you are a healthy person carrying this bacterium, you wouldn’t know you had been colonized with it,” Johnson said. “It only really causes disease in the immunocompromised, like the elderly.”
E. cloacae is well known for causing wound infections, urinary tract infections and even sepsis in the elderly and immunocompromised.
This bacterium has specifically evolved to become resistant to multiple antibiotics, including one of the so-called “last line” antibiotics called carbapenems. They are considered the last-resort treatment for certain diseases. E. cloacae has also become resistant to disinfectants and heavy metals, which are commonly used in the healthcare environment.
The bacteria in the study came from patients in Minnesota and eastern North Dakota from 2009 to 2013. Johnson looked at the genome sequences that were resistant to carbapenems, which showed that all of the E. cloacae originated from a common recent ancestor.
“This provides evidence for the origin of this multidrug resistant clone in the Fargo-Moorhead area, followed by its spread over time through nursing homes and hospitals in western Minnesota, and more recently in the Twin Cities metro area,” Johnson said.
There is also evidence of resistance between bacteria within the same patient. Johnson found the plasmid in this study carrying its antibiotic resistance-encoding genes connects with E. coli. This E. coli can be treated with some antibiotics, but if it partners with the plasmid from the E. cloacae bacteria, it can become resistant to nearly all forms of antibiotic therapy.
“This shows resistance to multiple antibiotics can be spread on plasmids, between bacteria, and even within a patient’s gut, to make bad bacteria even worse,” Johnson said.
Johnson hopes this research will encourage healthcare facilities to improve or add surveillance programs. He says the single best way to prevent the spread of these types of bacteria continues to be diligent hand washing.
“Bacteria like this may be circulating under our noses undetected, throughout the community,” Johnson said. “They only surface when causing infections in hospitals and long-term health care facilities, where they are most dangerous.”
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