A new and deadly superbug
has infected patients at one of America's most celebrated hospitals. The National Institutes of Health
in Bethesda, Maryland is battling an outbreak that has already infected nineteen patients and killed seven. Canadian doctors are paying close attention. I'll tell you why you should too.
The superbug is called Klebsiella pneumoniae carbapenemase
or KPC. Klebsiella pneumoniae
is a bacterium that lives harmlessly in the large intestine. Most of the time, it just lives there without causing an infection. In debilitated patients, the non-superbug version of Klebsiella can cause urinary tract infections, pneumonia and other kinds of infections. This particular bacterium can also cause a sepsis - a life threatening infection of the blood. With Klebsiella infections, the patient has a high fever and is really sick. The treatment is a class of antibiotics called Carbapenems.
They have names like Imipenem and Meropenem.
Unfortunately, a new version of Klebsiella is resistant to Carbapenems; hence, the name KPC.
The outbreak at the NIH began with a single patient infected with KPC. Over six months, the superbug began to spread. Pretty soon, a patient a week was reportedly catching the germ. As Associated Press reporter Lauran Neergaard put it here,
the way doctors at NIH uncovered the outbreak is a story worthy of the TV program CSI
. Medical microbiology sleuths were able to isolate the bacterium from all of the infected patients as well as from patients and hospital workers who were carriers of the germ. Then, they used a technique called fast sequencing
to quickly map out the DNA sequence of the bacteria isolated from each patient. All of them bore the same genetic fingerprints, meaning they had spread from patient zero.
Here's why this particular germ worries doctors. Most superbugs can still be treated with at least one antibiotic. At the best of times, the non-superbug version of Klebsiella pneumonia may only be susceptible to antibiotics that belong to the Carbapenem family. If a patient is infected with the strain of KPC at the heart of the NIH outbreak, there's a good chance that there is no antibiotic on earth that can stop it.
The patients most susceptible to contracting KPC are critically ill and/or have a weakened immune system, which is why outbreaks easily occur in hospitals. While that may be of some comfort to the rest of us, it's bad news to susceptible patients who are generally in no shape to fight it off, which is why the mortality rate is so high.
To control the outbreak, the NIH has set up some of the most stringent infection control procedures imaginable. In an effort to eradicate the KPC superbug, the hospital has isolated patients with actual and suspected infection. It has disinfected surfaces again and again. As a result of that genetic CSI work I was telling you about, doctors found the KPC superbug hiding in sink drains as well as inside a ventilator. To stop the bug, entire sinks have been disassembled and vents cleaned with bleach. The hospital has tested and retested patients and health professionals looking for carriers of the superbug. It went on an aggressive campaign to demand more stringent hand washing.
All of that seemed to be working. As recently as the middle of August, NIH hospital officials were boasting that the outbreak had peaked with 18 cases and six deaths. But the most recent case - the boy from Minnesota who died of a KPC infection (as reported in the Washington Post)
- forced officials at the NIH to once again apologize for the outbreak and to announce it's redoubling efforts to control the infection and to test and (if necessary) decontaminate every inch of the place.
You may be wondering whether Canadian hospitals are safe. The KPC superbug can spread from hospital to hospital. That's how it got to the NIH in the first place. It was transmitted by a woman who herself contracted the germ from a hospital in New York City. The woman unintentionally brought the KPC superbug to the NIH when she was transferred there to participate in a research study.
That said, it's unlikely the NIH outbreak will spread directly to Canada. Still, this may surprise you but we've already had cases of KPC in Canada.
In 2010 and 2011, Jewish General Hospital in Montreal became one of the first -- if not the first -- in Canada to deal with an outbreak of KPC. At the time, the head of infection control at the hospital said the type of KPC that was detected at the hospital could be treated with two antibiotics, including an older drug with severe side effects. And the Ottawa Hospital had three cases of KPC - one of which was resistant to all antibiotics. The woman infected with that particular superbug eventually died. A medical microbiologist connected to the case told Canadian Press it was a "nightmare scenario" which is an apt description.
This isn't science fiction. This is our future, unless we develop new antibiotics, new ways of combating superbugs or better ways of controlling outbreaks. Fortunately, people with healthy immune systems aren't susceptible to this bacterium. Don't be so sure about the next one.