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G7 told to act on antibiotics as dreaded superbug hits U.S.

The U.S. has recorded its first case of resistance to last-resort drug, but it has already surfaced in Canada and Europe

Britain told the G7 industrial powers on May 27 to do more to fight killer superbugs as the United States reported its first patient with bacteria resistant to a last-resort antibiotic.

U.S. scientists said the infection in a 49-year-old Pennsylvania woman “heralds the emergence of truly pandrug-resistant bacteria” because it could not be controlled even by colistin, an antibiotic reserved for “nightmare” bugs.

In Japan, British Prime Minister David Cameron said leading countries needed to tackle resistance by reducing the use of antibiotics and rewarding drug companies for developing new medicines.

“In too many cases antibiotics have stopped working. That means people are dying of simple infections or conditions like TB (tuberculosis), tetanus, sepsis, infections that should not mean a death sentence,” he told a news conference at a summit in Japan.

“If we do nothing about this there will be a cumulative hit to the world economy of $100 trillion and it is potentially the end of modern medicine as we know it.”

A review commissioned by the British government and published last week said a reward of between $1 billion and $1.5 billion should be paid for any successful new antimicrobial medicine brought to market.

If the problem is not brought under control, antimicrobial resistance could kill an extra 10 million people a year by 2050, the review warned.

Wake-up call

The U.S. case is a further wake-up call for the world, although it is not the first time that colistin resistance has appeared.

Medics were alarmed last year by the discovery in China of a new gene that makes bacteria highly resistant to the medicine. Since then, the deadly strain has also been detected in Europe and Canada.

Coinciding with the U.S. case are reports that the Centre for Disease Control and the USDA are reporting a swine intestinal infection with the same mcr-1 positive E. coli strain but there was no evidence linking the two findings.

The development of colistin resistance is linked to the drug’s widespread use in livestock and the European Medicines Agency on May 26 called for a 65 per cent cut in the amount of the medicine used in farming.

“The more we look at drug resistance, the more concerned we are,” Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, told reporters in Washington.

“The medicine cabinet is empty for some patients. It is the end of the road for antibiotics unless we act urgently.”

The problem is aggravated by drug makers’ reluctance to invest in developing new antibiotics, preferring to focus on more profitable disease areas, although recently there has been some increase in investment, prompted by the superbug threat.

In January, 83 companies, including Pfizer, Merck & Co, Johnson & Johnson and GlaxoSmithKline, signed a declaration urging governments to support work on new antibiotics.

“We risk being in a post-antibiotic world,” Frieden said, speaking at a National Press Club luncheon in Washington, D.C.

The infection was reported May 26 in a study appearing in Antimicrobial Agents and Chemotherapy, a publication of the American Society for Microbiology. It said the superbug itself had first been infected with a tiny piece of DNA called a plasmid, which passed along a gene called mcr-1 that confers resistance to colistin.

“(This) heralds the emergence of truly pandrug-resistant bacteria,” said the study, which was conducted by the Walter Reed National Military Medical Center. “To the best of our knowledge, this is the first report of mcr-1 in the U.S.”

Symptoms

The patient visited a clinic on April 26 with symptoms of a urinary tract infection, according to the study, which did not describe her current condition. Authors of the study could not immediately be reached for comment.

The study said continued surveillance to determine the true frequency of the gene in the United States is critical.

“It is dangerous and we would assume it can be spread quickly, even in a hospital environment if it is not well contained,” said Dr. Gail Cassell, a microbiologist and senior lecturer at Harvard Medical School.

But she said the potential speed of its spread will not be known until more is learned about how the Pennsylvania patient was infected, and how present the colistin-resistant superbug is in the United States and globally.

In the United States, antibiotic resistance has been blamed for at least two million illnesses and 23,000 deaths annually.

The mcr-1 gene was found last year in people and pigs in China, raising alarm. The potential for the superbug to spread from animals to people is a major concern, Cassell said.

For now, Cassell said people can best protect themselves from it and from other bacteria resistant to antibiotics by thoroughly washing their hands, washing fruits and vegetables thoroughly and preparing foods appropriately.

Experts have warned since the 1990s that especially bad superbugs could be on the horizon, but few drug makers have attempted to develop drugs against them.

Frieden said the need for new antibiotics is one of the more urgent health problems, as bugs become more and more resistant to current treatments.

Overprescribing of antibiotics by physicians and in hospitals and their extensive use in food livestock have contributed to the crisis.

More than half of all hospitalized patients will get an antibiotic at some point during their stay. But studies have shown that 30 per cent to 50 per cent of antibiotics prescribed in hospitals are unnecessary or incorrect, contributing to antibiotic resistance.

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