FEATURE
Arkansas resident Tamika Capone traveled to Tijuana last October for low-cost
bariatric surgery and came home with a superbug—VIM-producing carbapenem-
resistant Pseudomonas aeruginosa (VIM-CRPA), an organism the US Centers for
Disease Control and Prevention (CDC) considers a serious health threat.
As quoted in The Washington Post, her Little
Rock physician said “I’ve not yet had a
patient with zero [treatment] options, but
this is as close as I’ve had.”
Capone started on a course of colistin—
a last-resort antibiotic that can trigger
kidney and nerve damage—but stopped
treatment after her face and tongue went
numb. Now, as The Post reports, she has an
infected hole at the abdominal incision
site, and it won’t heal and “hurts a lot.” If
the highly drug-resistant bacterium enters
her bloodstream, the infection could well
be fatal.
Welcome to a world without antibiotics.
Although VIM-CRPA is uncommon in the
United States—86 cases were reported to
CDC through 2017—Capone’s experience
is a preview of what will certainly happen
if our antibiotic pharmacopoeia becomes
irrelevant.
Given the global rise of drug-resistant
pathogens over the past few decades,
some physicians and scientists warn
of a possible antibiotic apocalypse—a
scary, post-antibiotic era. Marion Kainer,
MD, MPH, an infectious disease expert
who directs the Healthcare-associated
Infections and Antimicrobial Resistance
Program at the Tennessee Department of
Health (TDH), said such a fate “is definitely
a valid threat.” She said, “We have patients
who have untreatable organisms right
now. This is not something that’s in the
future. Fortunately, in the US it is still
relatively rare.”
A $160 million CDC effort now aims to
keep antibiotic resistance rare. And the
keystone of this effort is the Antibiotic
Resistance Laboratory Network (AR Lab
Network). Established in 2016, the AR
Lab Network comprises public health
laboratories in 50 states, five cities and
Puerto Rico, including seven regional
laboratories with advanced testing
PublicHealthLabs
@APHL
APHL.org
Arianna Allgood and Erica Terrell read AST plates.
Photo: TDH DLS
capabilities and the National Tuberculosis
Molecular Surveillance Center overseen by
the Michigan Department of Health and
Human Services.
It was the AR Lab Network that generated
the data linking Capone to a handful
of other CRPA-infected patients who
received healthcare in Tijuana. According
to The Post, eight of these patients,
including Capone, had surgery at the
same hospital. Thanks to the AR Lab
Network’s scientific work, CDC issued
a travel alert with recommendations
for patients who had invasive medical
procedures in Tijuana and for clinicians
who might treat CRPA-infected
individuals. The agency also contacted
Mexican health authorities, who pinned
the outbreak on poor infection control
practices and temporarily closed Tijuana’s
Grand View Hospital.
As of April 20, 2019, the VIM-CRPA
outbreak associated with Grand View
Hospital appears to be over. But without
the AR Lab Network, it might never have
been detected.
Summer 2019 LAB MATTERS
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