Super bugs: what should you know?
Wading through the hype with a microbiologist to get the facts
Our national dialogue concerning healthcare and medicine often involves discussing best and worst practices for distributing antibiotics. The specter of an unknown ‘super bug,’ immune to all modern medicine, has always cast an ominous shadow under which concern and angst grew strong. That fear peaked with the discovery of the first true super bug, resistant to all of our current technology.
It’s easy to find ourselves caught up in the hysteria. The very concept of an unkillable bug sparked the imagination of Hollywood’s greatest filmmakers. What if, they asked.
Well, what if? I thought this might be an appropriate moment to pull back the media curtain and speak with an expert in the field, Michigan State University’s Dr. Shannon Manning, who studies deadly pathogens day-in and day-out.
Adrian de Novato: Thank you for speaking with me, Dr. Manning. Could you give a brief overview of what you do and where you work?
Dr. Manning: I work at Michigan State University in the Department of Microbiology and Molecular Genetics. My research team studies how bacterial pathogens [bacteria able to cause infections] evolve as well as the mechanisms that they use to cause disease in people. We have studied antibiotic resistance in multiple pathogens and are trying to identify new methods to kill these pathogens.
Adrian de Novato: People are worried. But should they be? What is the objective risk of this super bug becoming something bigger than it currently is?
Dr. Manning: Yes, we should all be concerned. According to the CDC, antibiotic resistant infections affect up to 2 million people each year and contribute to 23,000 deaths. The identification of common pathogens with new traits like resistance to Colistin [a powerful antibiotic] could result in an increase in these numbers due to our inability to treat the infections.
Many pathogens like E. coli can readily acquire DNA containing resistance genes that allow them to survive in the presence of specific antibiotics and hence, they become resistant to antibiotic killing. [Bacteria have the ability to absorb random bits of DNA that they come in contact with as they move about.]
Acquisition of DNA containing resistance genes can occur in any environment including humans, soil, farm animals, etc. The emergence of Colistin resistance in E. coli occurred because the bacterium acquired DNA containing genes that it can use to survive in the presence of Colistin. This is particularly worrisome as other bacteria can also readily acquire these genes resulting in the emergence of new Colistin-resistant pathogens.
Adrian de Novato: As a scientist, how does the existence of this new bug help you better protect people going forward? Is there a silver lining in this discovery?
Dr. Manning: We now have the opportunity to develop new diagnostic tests to more rapidly identify E. coli or other pathogens with similar characteristics, and to enhance surveillance efforts nationwide to ensure that patients with Colistin resistant infections are identified quickly and monitored more carefully. We can also begin to identify factors associated with the acquisition of plasmid DNA in specific bacterial pathogens [bacteria absorbing random DNA that could make it resistant to antibiotics], and develop new methodologies to kill the resistant pathogens.
Adrian de Novato: In your opinion, is the research to identify, analyze, and develop effective solutions to antibiotic resistance sufficiently funded?
Dr. Manning: Recently, we have seen an increase in the number of funding opportunities from numerous agencies that encourage scientists to determine how resistance emerges in bacterial pathogens outside the human host (e.g., agriculture settings, the environment). Additional calls have focused on identifying new drugs or therapeutics that can kill or inhibit the growth of resistant pathogens. These funding opportunities are in line with President Obama’s 2016 budget, which proposed a $1 billion investment in federal funding for antibiotic resistance research.
Adrian de Novato: Would you like to see changes in how this research is conducted on a national scale? Could we be doing more?
Dr. Manning: Pathogens are constantly evolving and acquiring new traits. It is very difficult to predict how and when these pathogens will emerge and how many people will be affected, but understanding their characteristics and making comparisons to other pathogens recovered in different locations is imperative.
This is the basis for the CDC’s PulseNet, a molecular typing surveillance system that compares the genetic signature of specific foodborne pathogens isolated from cases in different geographic locations. Numerous foodborne outbreaks have been detected using this system.
Because technology has improved considerably since the emergence of the first antibiotic resistant pathogen, we are now armed with more sophisticated tools that can provide the entire genome of a pathogen in a few days.
Widespread utilization of these tools and standardization of analytical methods will be extremely important for researchers in the near future in order to more rapidly identify cases and limit the spread of untreatable infections [through isolation].
Similarly, the widespread adoption of antibiotic stewardship programs is critical at all levels including human and veterinary health, and agriculture to limit the emergence and spread of resistant pathogens. These types of practices will require more extensive collaboration among researchers in many different settings.
Editorial notes are italicized in brackets for clarity.