Research

Study outlines ‘perfect storm’ that led to Colombia’s antibiotic resistance epidemic


Cesar-Arias
By Hannah Rhodes | November 9, 2017

The nearly simultaneous emergence of a gene responsible for producing carbapenemases – enzymes that kill the most powerful antibiotics used against life-threatening, multidrug-resistant bacterial infections – coupled with the introduction of a bacterial clone that spread between patients created the “perfect storm” that led to today’s antibiotic resistance epidemic in Colombia. Results of this study, led by investigators from The University of Texas Health Science Center at Houston (UTHealth), Universidad El Bosque and Case Western Reserve University, have been published in the Journal of Infectious Diseases.

Senior author Cesar Arias, M.D., Ph.D., professor and director of the Center for Antimicrobial Resistance and Microbial Genomics at McGovern Medical School at UTHealth, and his fellow researchers found that the epidemic began with what he described as a “promiscuous” carbapenemase gene that spread horizontally across a particular type of Gram-negative bacteria. The gene produced an enzyme that broke down powerful carbapenems, the “last-resort” reliable antibiotic drugs used to treat Gram-negative bacteria. The origin of the gene is still unknown, but it spread rapidly from patient to patient throughout the country.

Researchers sequenced the genomes of 133 samples of Klebsiella pneumoniae, a bacterium that can cause serious illness including bloodstream infections, wound infections, pneumonia and meningitis. The samples, recovered from 24 hospitals across Colombia, were collected between 2002 and 2014, before and after the emergence of carbapenem resistance in these organisms. Colombia has a high density of antibiotic-resistant organisms compared to other countries and like many others, is struggling to combat an epidemic.

To exacerbate the crisis, shortly after the spread of the gene, a bacterial clone carrying a similar antibiotic-killing gene was introduced into the country, most likely via an infected patient who traveled from the U.S., where the clone was already present. This bacterial lineage carried multiple antibiotic resistance determinants and quickly spread through person-to-person contact, as happened before in other countries.

“With the availability of these data, we could pinpoint the major drivers of the epidemic: when the first strain was identified, how it was disseminated and how it reached this level of epidemic,” said Arias, who is also director of the Center for Infectious Diseases at UTHealth School of Public Health.

The approach used in this paper could help Colombia and other countries working to combat antibiotic resistance.

“If you have a bacteria passing from one patient to another, you can enact very strict infection control measures to stop an epidemic,” said Arias. “But how do you stop a gene passing from bacteria to bacteria if you can’t see it? The dissemination of the gene was fueled by the overuse of antibiotics because it could not easily be treated.”

According to Arias, this approach could potentially help researchers and health care providers target specific clinical settings where the gene is being disseminated versus where the clone is and enact either infection control or antibiotic stewardship measures.

“By tracking the molecular epidemiology of an epidemic like this, Laura Rojas and the team uncovered important lessons that will help us combat other resistant bacteria,” said Robert A. Bonomo, M.D., coauthor on the paper and professor of medicine at the Cleveland VA Medical Center and Case Western Reserve University School of Medicine. Laura Rojas was first author on the paper and is a graduate student at Case Western Reserve University School of Medicine.

Researchers from Case Western Reserve University; Louis Stokes Cleveland VA Medical Center; Jackson Laboratory for Genomic Medicine; International Center for Medical Research and Training in Cali, Colombia; International Center for Microbial Genomics Universidad El Bosque in Bogotá, Colombia; American Museum of Natural History; University of Pennsylvania and Children’s Hospital of Philadelphia were coauthors on the paper.

The research was funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases grants K24-AI114818, R01-AI093749, R21-AI114961 and R21/R33-AI121519 (awarded to Arias) and grants R21AI114508, R01AI100560, R01AI063517 and R01AI072219 (awarded to Bonomo). Funds and facilities from the Cleveland Department of Veterans Affairs, VISN 10 Geriatric Research Education and Clinical Center and the Veterans Affairs Office Research and Development (1I01BX001974 to Bonomo) also supported the work.

Tags |



Social Posts

profile_image

MD Anderson Cancer Center

@MDAndersonNews

How Richard Manning enjoys life during #colorectalcancer treatment: https://t.co/ED3Lgo0qVI #CancerMoonshot #crcmsm #endcancer https://t.co/m9DJDHEzck

26 mins ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

The three focus areas of our Prostate #CancerMoonshot: - overcoming treatment resistance - exploring #immunotherapy - understanding the tumor environment Learn more: https://t.co/0ZQCm8tMdR #PCSM #endcancer

11 hours ago
profile_image

Rice University

@RiceUniversity

The @GlasscockSchool's fall course catalog is chock-full of offerings for ever-curious learners, including classes in the humanities and sciences, foreign languages and personal and professional development. https://t.co/A793BrcLfz https://t.co/8a1K8LbHE2

12 hours ago
profile_image

Veterans Affairs

@DeptVetAffairs

Last Shasta County Navy Veteran who survived Pearl Harbor attack laid to rest https://t.co/lc5ODzbk9l via @JimSchultz_RS

12 hours ago
profile_image

BCMHouston

@bcmhouston

One internal medicine resident looks back at a time where a patient helped him realize the balance of overly identifying with patients and complete detachment. https://t.co/7xsFWEhVc4

12 hours ago
profile_image

Veterans Affairs

@DeptVetAffairs

Santa Clarita Air Force Veteran Launches Campaign For Web Series To Depict Modern Soldier Life https://t.co/Td0ds3jxue via @KHTSRADIO

14 hours ago
profile_image

Veterans Affairs

@DeptVetAffairs

Today’s #VeteranOfTheDay is @USArmy Veteran Stanley Nelson. https://t.co/SHml8yEysj

14 hours ago
profile_image

U.S. Department of Veterans Affairs

VeteransAffairs

Today’s #VeteranOfTheDay is Army Veteran Stanley Nelson. Stanley served from 1949 to 1952.Stanley, from Otwell, Indiana in Pike County, joined the Army in 1949 and completed training at Fort Knox. He was sent to Japan and in 1950 was assigned to the 8th Engineer Combat Battalion, 1st Calvary in Korea during the Korean War. On February 14, 1951, Stanley was defending the flank of advancing soldiers near Chipyong in modern-day South Korea. He was wounded by small arms fire in the right shoulder, right foot, left leg and left foot. Stanley was left incapacitated and was captured by the enemy.Stanley endured torture and difficult conditions while held prisoner and was left to die. However, American forces discovered him and evacuated him for medical treatment. The lower part of Stanley’s leg was amputated the following month and he recovered at Percy James Army Hospital in Battle Creek, Michigan. He was medically retired on January 31, 1952.Thank you for your service, Stanley!

14 hours ago
profile_image

UTHealth

@UTHealth

Thank you @MBThewoodlands for supporting student scholarships at @MDA_UTHGrad! It also is hosting our next House Calls web chat on sports medicine this Thursday, July 19, at 6:30 p.m. CST at https://t.co/N5UU1Jx4pq. Submit a question for our experts by using #UTHealthHouseCalls.

14 hours ago
profile_image

UTHealth

@UTHealth

RT @abc13houston: The most common sports injuries are strains and sprains, but do you know when you might need to see a doctor? The experts…

14 hours ago
profile_image

BCMHouston

@bcmhouston

RT @BCMHouston_News: Tune in to @FOX26Houston tomorrow in the 8 am hour to hear @bcmhouston's Dr. El-Serag discuss the recent CDC report on…

15 hours ago
profile_image

MD Anderson Cancer Center

@MDAndersonNews

#Cancerpain can be related to the disease and treatment. Hear from Dr. Salahadin Abdi on how patients can find relief. #endcancer https://t.co/snFVjDUjNe

15 hours ago
profile_image

TexasHeartInstitute

@Texas_Heart

RT @HealthyWomen: 10 Sneaky Ways to Get Fruits and Veggies in Your #Diet: https://t.co/wJ9x39147k #health https://t.co/EWktCmct2J

15 hours ago
profile_image

BCMHouston

@bcmhouston

RT @BCMHouston_News: Certain nail products can cause allergic reactions or irritations. @bcmhouston's Dr. Katta shares what to look out for…

16 hours ago
profile_image

Rice University

@RiceUniversity

RT @RiceAthletics: To celebrate #WorldEmojiDay, check out our favorite mascot @SammyTheOwl! 🦉👐 https://t.co/ebIKcsu2Z9

16 hours ago