By David Wallinga, MD
Kids can die from superbugs, just as adults do. But a new study last week was among the first I’d seen to dive more deeply and specifically into how this superbug crisis threatens your kids.
The study’s findings, which the author called “ominous,” appeared in the Journal of the Pediatric Infectious Disease Society. One takeaway was that infections among hospitalized kids due to one nasty superbug, called multidrug-resistant (MDR) Enterobacteriaceae, rose a dramatic 750 percent from 2007 to 2015. One particular variety of the same menace tops a new World Health Organization priority list of global bacterial superbug threats released Monday.
Enterobacteriaceae are a particularly problematic family of gram negative bacteria that includes E. coli, Klebsiella and Salmonella. It’s also among the many such superbugs that we already know are found in the U.S. food supply and on farms, as Natural Resources Defense Council’s Carmen Cordova blogged Monday.
Strains of Enterobacteriaceae have been popping up in U.S. patients that are pan-resistant (resistant to every medicine), or nearly so, including to colistin and carbapenem, two drugs of last resort that doctors rely upon when all else fails. On U.S. hog farms, too, they’ve found super-resistant Enterobacteriaceae, some of them carrying resistance to colistin or carbapenems, even thought neither is thought to be used in U.S. hog production.
— EcoWatch (@EcoWatch) December 11, 2016
This study looked over an eight year time period at 94,000 kids discharged from children’s hospitals, and who’d also had infections due to Enterobacteriaceae—mostly E. coli urinary tract infections, as it turns out. Thankfully, none of the infections were pan-resistant. But by the end of the period, in 2015, 15 of every thousand of these kids had had infections resistant to multiple antibiotics—more than seven times higher than the incidence among the kids being discharged eight years earlier. Moreover the kids with resistant Enterobacteriaceae infections had hospital stays 20 percent longer compared to kids whose infections were not resistant.
The incredibly rapid rise in MDR Enterobacteriaceae infections among kids is especially ominous. Younger patients have less developed immune systems than adults, so are less able to mount an effective defense against such infections. Much less recognized is the fact that there simply aren’t as many antibiotics available to treat sick kids as there are for adults; rising resistance to existing medicines only compounds the already limited choices facing a pediatrician.
One final, worrisome note. To date, super-resistant infections caused by gram negative bacteria like the Enterobacteriaceae have mostly been a problem in hospitals. The fear, and the expectation, was that as resistance worsened, infections would begin to arise among healthier populations out in community settings, as well. But in this study, more than three-quarters of the children with multidrug-resistant infections came to the hospital already infected. That means they contracted those infections from friends, families, food or farms—somewhere else in the community—and not from other patients or staff while in the hospital.
Driving the development and spread of superbugs like this one are U.S. federal policies that still allow the antibiotics important to humans to be routinely given en masse to flocks and herds of food animals, at low doses and over long periods of time in the animal feed or water. Absent tighter federal controls, it’s critical that states step up to the plate instead. In Maryland, the Keep Antibiotics Effective Act of 2017 is an important bill trying do just that, by ensuring antibiotics are only given to livestock when they are sick.
That’s the kind of leadership that’s needed to reverse the trend towards rising numbers of painful, expensive, and ever-harder-to-treat infections in children’s hospitals, including at Johns Hopkins, the University of Maryland and elsewhere.
David Wallinga is a physician with more than 20 years of experience in writing, policy and advocacy at the intersection of food, nutrition, sustainability and public health. Wallinga is the senior health officer at Natural Resources Defense Council.