The superbugs lurking in our midst

Salmonella invades a cultured human cell, Rocky Mountain Laboratories, NIAID, NIH, 2011, Modified

By SHAMIM ISLAM, MD

Published September 26, 2017

The data and projections are alarming. 70% of infections in babies with sepsis were multi-drug resistant in a private, metropolitan hospital in India. 

Up to 10 million deaths/year may be attributable to antimicrobial resistant infections – more than any other cause – by 2050
Pediatrics

NDM-1, a transmissible form of resistance to the powerful carbapenem antibiotic class, can consistently be found in public water supplies throughout South Asia. Mcr-1 and 2, the newest resistance-mechanisms of concern, whose emergence is suspected to be related to widespread use of colistin in animal agriculture, was first described in China in 2015, but now has been detected on every continent. Up to 10 million deaths/year may be attributable to antimicrobial resistant infections – more than any other cause – by 2050; like most global issues, the problem is inequitably distributed, with ~ 90% to occur in Asia and Africa.

Antimicrobial resistance (AMR), particularly in a framework of global interconnectivity, is my deepest scholastic interest. As a pediatric infectious diseases physician right out of fellowship training, I was drawn to this area after caring for four otherwise healthy American toddlers who required prolonged hospitalization for multi-drug resistant (MDR) E. coli urinary tract infections, who’d all recently returned from family trips to South Asia. I learned through the then early literature that international travel is a significant risk factor for MDR-bacterial acquisition and infection. In the last few years, various studies have shown that intestinal colonization of MDR-bacteria is common in developing countries, is steadily increasing, and can newly occur in travelers even after short trips abroad. Unlike other global health equity challenges – but classic for infectious diseases – antibiotic-resistance is a threatening hydra capable of not only spreading rapidly, but establishing itself throughout large populations, which no person or nation can truly escape.  

Through the Community for Global Health Equity, I’ve been connected with other UB faculty committed to better understanding, and ultimately combatting, global antimicrobial resistance (AMR). While the gravity of AMR gains increasing attention, there is much still unknown about its drivers and transmission dynamics. While suspected to be a significant factor, the impact of antibiotic use in agriculture – not only in livestock animals, but also in fisheries and vegetable and fruit cultivation – remains poorly characterized. To what extent does accumulated antimicrobial residue in the environment select for AMR, at both a bacterial and genetic level? How fluidly is AMR spread in water; what are the effects of naturally-occurring phenomenon, such as monsoons and floods? How easily do humans pick-up AMR from water and food sources, and how stable is this carriage?

To initiate studies exploring these areas, our UB AMR research group was fortunate to be supported by CGHE to travel to Bangladesh in July. With Dr. Jared Aldstadt, a Geographer with experience in GIS and spatio-temporal analysis related to infectious diseases, and Dr. Diana Aga, an expert in environmental chemical analysis, our team met with new collaborators at icddr,b and considered field sites. Visiting rivers downstream of wastewater collection facilities in the megalopolis of Dhaka, and Matlab, the rural icddr,b surveillance post renowned for decades of excellent epidemiologic study – were most beneficial as we define our research proposals. Above all, the opportunity to directly meet with established scientists at icddr,b, to discuss ideas, and best understand their excellent capacity in microbiology, environmental sampling, and field research, were invaluable. With this experience, and the ongoing auspices of CGHE, our now international collaborative team aims to pursue serial investigations related to environmental AMR presence and dissemination, and human intestinal AMR carriage. Ultimately, we hope that our efforts may better inform AMR mitigation and prevention strategies.