A new report of widespread colonization and infection by a superbug- (carbapenemase-resistant Klebsiella) is just out, and it is truly alarming. Not sure why it hasn’t cracked the mainstream press yet.
I don’t have access to the full report, but Jon Otter has published a good summary which I will quote here, although you absolutely should read his take on it:
- 45% of patients became colonised with carbapenem-resistant bacteria. Yep, almost half.
- The median time to colonisation was just 8 days.
- Even worse, 10% of the total number of patients (which is 27% of those who became colonised) developed a bloodstream infection.
- Even worse still, the median time from colonisation to BSI was a remarkably short 4 days.
- Klebsiella pneumoniae strain ST258 accounted for all the carbapenem-resistant bacteria in the isolates tested (the matching isolates from the rectal screen and BSI from the 48 patients with BSIs).
These results are from a single Greek ICU and so maybe they are just a wild outlier that is of no wider significance. Greece itself is an outlier for carbapenem resistance. Most of Europe has a handle on carbapenem resistance in Klebsiella, with rates typically < 5%:
Even Italy and Romania (the other red countries) have rates around 30%, while Greece is near 70% (in 2016).
Maybe the Greeks are just really bad about overusing carbapenems. If that were the case, we might expect to see high levels of carbapenem resistance in other bugs like E coli. But we don’t:
This suggests that other factors are in play. Disruption of the Greek healthcare system by austerity measures is almost certainly one of them.
But another possibility is that Klebsiella pneumoniae ST258 has emerged as a true superbug. Real superbugs–as opposed to the many fake ones proclaimed by click-hungry journalists–are not merely resistant to antibiotics. Resistance usually comes with a fitness cost, and resistant organisms tend to infect patients already weakened by other other maladies.
To be a superbug, a bug must not merely be resistant, but must also acquire compensatory mutations that increase its fitness, as well as virulence factors that increase its ability to sicken otherwise healthy people. The MRSA strain USA300 is a prime example of a true superbug. I’m not sure there is a second example.
ST258 has been under suspicion as a possible superbug candidate for a while now, although one study did not find compelling evidence for this.
But such studies are always backwards-looking, and it is entirely possible that ST258 has acquired new virulence factors recently (Strain Types are determined on the basis of housekeeping genes, and don’t change upon acquisition of virulence genes).
So is it possible that the superbug apocalypse really is here? The one that I have been dismissing for some time now?
I don’t think so. The spread of ST258 is a disaster, not an apocalypse. The difference? Hurricanes are disasters. Climate change is an apocalypse. Far too many people were killed and displaced by Katrina, but day-to-day life in the US, and even in most of Louisiana, carried on as though nothing happened. Universities created and transmitted knowledge; students took that knowledge and filled jobs and created businesses. People sent their kids off to school and to other activities without worrying they might contract a deadly disease. Our modern economy of constant change and innovation carried on, just as before.
ST258 may kill far more people than is just or right, but it is no threat to modernity. It can be contained through infection control efforts within hospitals, and by provision of clean water outside hospitals. No breakthrough discoveries are required, just the timely and prudent deployment of resources. Containing ST238 would not be that different from building sturdy houses away from flood zones after a hurricane. It’s something that we could have done before, and should have done before, but are certainly capable of doing now.
By contrast, we really don’t know how to stop the spread of a killer influenza or drug-resistant TB–no more than we can contain sea-level rise or the desertification of agricultural lands. We know that both these diseases are capable of killing large numbers of adults in their prime–adults who are raising families, starting businesses, running the long chains of processes required to deliver food and water and energy and every kind of material good to cities so that they can keep innovating and creating wealth. Once that sort of system breaks down, it’s not at all clear how we start it up again. We’ve only had one Industrial Revolution, one Demographic Transition, and historians still debate the whys and hows of those singularities (I vote for germ theory as a key component).
Greece is hurting but fixable; ST258 is not bringing the End Times for modern medicine. The superbug apocalypse is not (yet) nigh.