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<p class="MsoNormal"><span style="font-size:12.0pt;color:#17365D"><a href="http://www.huffingtonpost.com/entry/infection-all-antibiotic-resistant_us_587960f4e4b0b3c7a7b16e29"><span style="color:blue">http://www.huffingtonpost.com/entry/infection-all-antibiotic-resistant_us_587960f4e4b0b3c7a7b16e29</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#0000CC"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Helvetica Neue","serif";color:#2E7061;letter-spacing:.6pt"><a href="http://www.huffingtonpost.com/section/healthy-living"><span style="color:#2E7061">HEALTHY LIVING
</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Helvetica","sans-serif""><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin-right:7.5pt;mso-line-height-alt:13.2pt"><span style="font-size:24.0pt;font-family:"Helvetica","sans-serif";color:black;letter-spacing:-.25pt">No Antibiotic In The U.S. Could Save This Woman. We Should All Be Worried.<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-top:3.75pt;mso-line-height-alt:16.8pt"><span style="font-size:18.0pt;font-family:"Helvetica Neue","serif";color:#757575">This is one of the first cases of a pan-resistant infection in America.<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:24.0pt"><span style="font-size:12.0pt;font-family:"Helvetica","sans-serif";color:#999999">01/13/2017 09:57 pm ET
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Helvetica","sans-serif";color:#999999"><a href="http://www.huffingtonpost.com/author/anna-almendrala"><span style="font-family:"Times New Roman","serif";color:#2E7061"><o:p></o:p></span></a></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#999999"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Helvetica","sans-serif";color:#999999"><a href="http://www.huffingtonpost.com/author/anna-almendrala"><span style="font-family:"ProximaNova-bold","serif";color:#2E7061;letter-spacing:-.1pt;text-decoration:none">Anna
Almendrala</span><span style="font-family:"Times New Roman","serif";color:#2E7061">
</span></a>Senior Healthy Living Editor, The Huffington Post <o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:21.0pt"><span style="font-size:13.5pt;font-family:"Helvetica","sans-serif";color:#222222"><img border="0" width="524" height="322" id="Picture_x0020_1" src="cid:image001.jpg@01D270CF.D2FE5470" alt="http://img.huffingtonpost.com/asset/crop_0_1017_3360_2068,scalefit_630_noupscale/58796255120000c301ad784d.jpeg?cache=ofcwdac3se"></span><span style="font-size:13.5pt;color:#222222"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:16.8pt"><span style="font-size:13.5pt;font-family:"Helvetica","sans-serif";color:#999999;text-transform:uppercase">Gary Cameron / Reuters
</span><span style="font-size:12.0pt;color:#999999;text-transform:uppercase"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">The <i>Klebsiella pneumoniae</i> organism in a petri dish.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">The <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6601a7.htm?s_cid=mm6601a7_e">
<span style="color:#2E7061">recent death of a woman in Reno, Nevada</span></a>, from an infection resistant to every available kind of antibiotic in the U.S. highlights<b> </b>how serious the threat of antibiotic-resistant superbugs has become. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">Experts say that while cases of a bacteria resistant to all antibiotics are still extremely rare in the U.S., we should expect to see more in the future. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">“This is an important case because it serves as a reminder to the health care community that these kinds of things can show up, even though they are rare,” said Randall Todd, director of epidemiology
and public health preparedness at the Washoe County Health District, who co-wrote a study on this case. “We do have other forms of drug resistance, but this is the first time we’ve seen one that is pan-resistant, meaning there was nothing in the medicine cabinet
available to treat this case.”<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">A woman in her 70s had just come back from a long visit to India when she was hospitalized on Aug. 18 and diagnosed with
<a href="http://emedicine.medscape.com/article/168943-overview#a3"><span style="color:#2E7061">systemic inflammatory response syndrome</span></a>: a fever, high heart rate, abnormal white blood cell count or an abnormal breathing rate in response to either
an infection or some other trauma.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">Before returning to the U.S., she had been hospitalized in India several times because she had fractured her femur and gotten an infection in the thigh bone and also her hip. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">One week after she was admitted, the hospital confirmed her infection was caused by a carbapenem-resistant Enterobacteriaceae (CRE) called <i>Klebsiella pneumoniae. Enterobacteriaceae</i> is
a kind of bacteria that can be a normal part of the human gut, but carbapenem-resistant ones don’t succumb to carbapenems — a class of antibiotics considered the last line of defense against bacterial infections. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">Doctors reacted immediately to the identification of the CRE. In keeping with national guidelines, they dedicated a select few staff to treat her exclusively and instituted strict hand-washing
protocol to keep the bug from spreading to other parts of the hospital. Thankfully, she was already in a single room.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">In their search for a potential cure for her infection, doctors later found out that the cause was resistant to all 14 antibiotics the facility had to offer. Further testing at the U.S. Centers
for Disease Control and Prevention confirmed that it was, in fact, resistant to all 26 antibiotics in the U.S. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">The patient developed sepsis and died in early September.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">The CDC <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6601a7.htm?s_cid=mm6601a7_e"><span style="color:#2E7061">published the details of this case Thursday</span></a> and noted that there
are three lessons to draw from her case. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">The first thing they emphasized is that bacteria resistant to all available antimicrobials are very uncommon. Of the more than 250 carbapenem-resistant bacteria samples they have tested so far,
80 percent could be controlled with at least one aminoglycoside (another class of antibiotics) and 90 percent were susceptible to tigecycline, an antibiotic that is
<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1426172/"><span style="color:#2E7061">effective against drug-resistant bacteria</span></a>. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">The case also underscored the importance of infection control, as the bug posed a serious threat to other patients in the hospital. The study notes that the hospital tested all the other patients
who were in the same unit and found that the CRE had not spread to them. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">Finally, knowing that the woman had been hospitalized frequently in India gave her doctors much-needed insight on the infection she could be facing. Antibiotic-resistant bacteria are more common
in other parts of the world, and knowing about international hospitalizations could give doctors clues into what they’re looking for, says Lei Chen, lead author of the report and the epidemiology program manager at Washoe County Health District in Nevada. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">Chen was in close contact with the treating hospital throughout the case, and her department interviewed the woman’s household family members for any signs of illness. They were all healthy. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">One problem with superbugs is that there’s no way to know where they are within a healthy population, explains Tim Johnson, an antibiotic resistance expert at the University of Minnesota’s Veterinary
School.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">“These are what have been referred to as the silent killers, because it’s not like salmonella, where you ingest the salmonella and get sick,” Johnson said. “You can acquire these things, and
they can hang out asymptomatically without causing disease for extended periods of time in your gut.” <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">He called the superbug issue a “slowly dripping faucet” that is going to leak more over time. In the meantime, the bottom line for U.S. doctors is that they should become more aware of the possibility
that people can bring these superbugs back from different parts of the world.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">“This is one of the first examples of a completely resistant bug,” Johnson concluded. “It’s definitely concerning — there’s no doubt about that. But it’s not something that we’re going to see
rise dramatically.” <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">How to resist antibiotic resistance <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">We’ve known about the threat of pan-resistant bacteria for a long time but haven’t done enough to prepare, said David Weiss, director of the
<a href="http://www.antibiotics.emory.edu/" target="_blank"><span style="color:#2E7061">Emory Antibiotic Resistance Center</span></a> in Atlanta. While the U.S. is taking encouraging steps to promote safe use of antibiotics, cut down on the use of antibiotics
in livestock and invest in surveillance, the Nevada case demonstrates that this is a global problem that requires a global solution. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">“One of the things that this case highlights is that people can pick up really nasty infections in other countries and then come home with them, so this is really a global problem,” Weiss said.
“This isn’t a problem that we’ll be able to address just domestically.”<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">In America, about 2 million people a year are infected with bacteria resistant to some antimicrobial agent, and of those,
<a href="https://www.cdc.gov/drugresistance/about.html"><span style="color:#2E7061">23,000 die of their infections</span></a>. Antibiotic resistance is also a rising threat throughout the rest of the world. European analysts modeling a “worst-case scenario,”
in which all microbes became resistant to medicine, estimated in 2014 that fatal superbug infections around the world could increase from
<a href="http://www.huffingtonpost.com/2014/12/11/drug-resistant-infections_n_6311720.html">
<span style="color:#2E7061">700,000 in 2014 to 10 million</span></a> by 2050. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">The World Health Organization launched a
<a href="http://www.who.int/mediacentre/factsheets/antibiotic-resistance/en/"><span style="color:#2E7061">global action plan in November 2015</span></a> that involves raising awareness of antimicrobial resistance, investing in research and making sure that
antimicrobial medicines are used properly. However, Johnson notes that antibiotic use in other parts of the world remain either unregulated or poorly regulated. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">There are steps people can take to protect themselves. Antibiotic use causes antibiotic resistance, which is why it’s important for doctors to prescribe them only when they have confirmed the
presence of a bacterial infection, not for a viral illness. Those who are prescribed antibiotics should take them exactly as instructed and not stop a course of treatment early, even though they might be feeling better. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">Chen also advised patients to let their health care providers know if they’ve ever been hospitalized in another facility, state or country, and she said they should insist that doctors wash their
hands before examining or touching them.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222">Outside of the health care facility, people can also protect themselves from antibiotic resistance by
<a href="https://www.cdc.gov/drugresistance/protecting_yourself_family.html"><span style="color:#2E7061">washing their hands regularly</span></a>, staying up to date on vaccines, preparing and cooking foods safely, and using protection during sex to prevent
the spread of infections.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:12.0pt;color:#222222">This reporting is brought to you by HuffPost’s health and science platform, The Scope. Like us on <a href="https://www.facebook.com/TheScopeHP/" target="_blank"><span style="color:#2E7061">Facebook</span></a> and <a href="https://twitter.com/TheScope" target="_blank"><span style="color:#2E7061">Twitter</span></a> and
tell us your story: <a href="mailto:scopestories@huffingtonpost.com" target="_blank"><span style="color:#2E7061">scopestories@huffingtonpost.com</span></a>. <o:p></o:p></span></i></p>
<p class="MsoNormal" style="line-height:21.0pt"><span style="font-size:13.5pt;font-family:"Helvetica","sans-serif";color:#222222"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;color:#000099">Deborah L. DeBiasi<br>
<b>Email: <a href="mailto:Deborah.DeBiasi@deq.virginia.gov"><span style="color:#000099">Deborah.DeBiasi@deq.virginia.gov</span></a><i><br>
</i></b>WEB site address: <a href="http://www.deq.virginia.gov/"><span style="color:#000099">www.deq.virginia.gov</span></a><br>
Virginia Department of Environmental Quality<br>
Office of Water Permits <br>
Industrial Pretreatment/Whole Effluent Toxicity (WET) Program<br>
PPCPs, EDCs, and Microconstituents<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;color:#000099"><a href="http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx"><span style="color:#000099">http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;color:#000099">Mail: P.O. Box 1105, Richmond, VA 23218<br>
Location: 629 E. Main Street, Richmond, VA 23219<br>
PH: 804-698-4028 FAX: 804-698-4032</span><span style="font-size:9.0pt;color:navy"><o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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