MCR-1: What you need to know about the ‘superbug’

Infected Pa. woman 'fine,' official says

Researchers say they may never know how a Pennsylvania woman contracted an infection with a gene that could lead to an antibiotic-resistant “superbug,” but they’re not in a panic, either.

For one thing, the gene could lead to an antibiotic-resistant strain of bacteria that is resistant to certain types of antibiotics — but not all antibiotics — federal and state officials said during a Tuesday conference call with reporters.

The bacteria made headlines for its resistance to Colistin, an antibiotic often seen as a “last resort” for stubborn infections, experts said, and not commonly used in this country.

Also, while officials could not release any information which might identify the patient, her prognosis seems positive, according to one federal official.

“The patient herself is fine, but we don’t have information yet which can tell us for sure whether the infection has been eradicated or not,” Dr. Beth Bell, director of the Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases, said.

What do you need to know? CDC and Pennsylvania Department of Health officials say that many standard anti-infection precautions apply — washing hands, avoiding contact with fecal matter and ensuring food is properly cooked.

We also consulted with local health care facilities to learn more.

Understanding MCR-1

State and CDC officials said researchers last fall discovered the MCR-1 gene among pigs and humans in China.

Identification of the gene in a Pennsylvania woman in April did not surprise researchers, who expected it to emerge in this country eventually.

“We live in a global society so it was inevitable,” explained Dr. Carrie DeLone, medical director of Holy Spirit Medical Group.

However, with the recent isolation of the gene in a Pennsylvania woman, “it is more important than ever to continue educating health care workers and the public about using antibiotics wisely,” DeLone added.

Kimberly Rivera, infection control manager at PinnacleHealth, echoed that theme.

MCR-1 is a multi-drug resistant organism, or MDRO, Rivera explained, which can develop when bacteria changes over time, making certain drugs ineffective.

“These changes occur most often because of repeated exposure to antibiotics,” Rivera said.

As DeLone explained, one answer may be reducing our reliance on such drugs.

“Most people with minor infections can overcome their infections without the use of antibiotics,” she said.

“Treating viral infections that don’t respond to antibiotics with antibiotics because patients want and expect them is not in the best interests of the population in the U.S.,” DeLone added.

Clinical approaches

Here are some steps health care facilities and providers can take to prevent the development of MDROs, according to Rivera:

• Choosing antibiotic treatment based on culture results. Cultures provide information on the infection and indicate which antibiotics will work the best.

• Prescribing the dose and treatment duration based on evidence-based guidelines.

• Developing pharmacy-based committees to review prescribing practices.

• Performing proper hand hygiene before and after every patient contact.

• Placing patients in the proper isolation to prevent the transmission of resistant organisms.

Rivera said PinnacleHealth has historically implemented “rigorous policies and process improvements aimed at reducing infections, including extensive and clearly defined policies on patient care.”

At Holy Spirit Geisinger, “there are strict policies regarding infection control including isolation of anyone suspected of having a multi-drug resistant organism, hand washing, waste disposal and identifying organisms that are high risk,” DeLone said.

“We will continue to be vigilant in identifying unusual organisms and working with the CDC and (Pennsylvania) Department of Health,” DeLone added. “The sooner these organisms are identified and stopped, the better.”

“Only use antibiotics when they will improve the patient’s outcome. These are the messages that Holy Spirit Geisinger is giving their patients and health care workers,” she said.

Dr. Joseph A. Torchia, senior vice president and chief medical officer at Holy Spirit, added that the facility’s staff is trained in universal infection control procedures, and has plans and protocols in place.

“The emergence of MCR-1 in bacterium, which is highly antibiotic-resistant, has reinforced adherence to established infection-control guidelines,” Torchia said.

“Our staff is trained and prepared to identify, isolate and care for patients who may have been exposed to antibiotic-resistant bacteria,” he added. “If someone presents to the hospital with a suspected infection, tests are done to culture specimens to determine the type of infection. We follow standard precautions for all patients, regardless of health status.”

Dan Carrigan, spokesman for WellSpan Health, said there is “no direct impact” to that system, but “this is an issue that is being closely monitored by our leadership.”

“To that end, we will continue to seek information and guidance from the Pennsylvania Department of Health and the Centers for Disease Control and Prevention,” Carrigan added.

“The safety of our patients, visitors and staff members is our highest priority. As this issue evolves, our mission of improving health through high-quality, patient-centered care will continue to be the guiding force for our work,” Carrigan said.

What patients can do

Rivera said patients can prevent the development of MDROs by:

• Following the provider’s prescription to the letter, even if you start to feel better after a few days. It is important to finish the entire prescribed course of treatment unless instructed not to.

• Not asking for an antibiotic when your provider doesn’t think it is necessary. Some infections, such as the common cold, are caused by viruses and antibiotics are not effective in treating them.

• Discarding any leftover medication when your treatment is complete.

• Washing your hands frequently throughout the day.

Agricultural considerations

Outside the halls of medicine, the MCR-1 issue could reverberate through the world of agriculture.

Colistin largely fell out of favor for human use because of its high toxicity. But as National Geographic reports, it found widespread use in some countries as an antibiotic for farm animals, especially in China.

Holy Spirit’s DeLone said it’s time “to re-evaluate the widespread use of antibiotics in livestock and other food animals.”

“If food is properly cooked, bacteria and other pathogens are killed, decreasing the need for inoculating them with antibiotics,” DeLone said.

“The use of antibiotics in animals increases the likelihood of antibiotic-resistant organisms developing in animals and spreading to humans,” she added.

Roger DuPuis
Roger DuPuis covers Cumberland County, health care, transportation, distribution, energy and environment. Have a tip or question for him? Email him at rdupuis@cpbj.com.

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