The alarm over the arrival of a grave new superbug in the United States is obscuring part of the story that is crucial to understanding what might happen next. Here it is: The woman who was carrying an E. coli containing resistance to the last-resort antibiotic colistin went for medical care because she had what felt like a routine urinary tract infection, a UTI for short.
The discovery of colistin-resistant bacteria is worrisome: Researchers have been watching for the arrival of this new superbug for several months. But that it was found in urine sample puts the discovery into a larger context.
Highly drug resistant urinary tract infections happen potentially hundreds of thousands of times a year just in the United States. A small, dedicated corps of researchers has been trying for years to emphasize that these infections represent a serious danger, an unexamined conduit of bacterial resistance from agriculture and meat into the human population, and have mostly been dismissed.
Now that the new-new superbug has thrown light on the problem, will someone listen?
The Centers for Disease Control and Prevention weighed in Tuesday with a statement and a press briefing with health officials from Pennsylvania, where, last week, military researchers said they found the mcr-1 gene in an E. coli bacterium carried by a woman living there.
There are up to 8 million urinary-tract infections in the U.S. each year, and probably at least 10 percent, or 800,000, are antibiotic-resistant.
The MCR gene is important because it represents a breach in the last line of antibiotic defense: It confers protection against colistin, one of the oldest antibiotics out there, and one of the few that continues to work even against bacteria that resist multiple other drugs. Colistin was seldom used in people until recently because it is toxic, but agriculture has been using it enthusiastically for decades, which has seeded resistance through the bacterial world.
And those highly drug-resistant bacteria are turning up in urinary-tract infections. Why UTIs? Because E. coli bacteria are carried in feces, which can easily spread to the urethra and cause urinary-tract infections, especially in women. I’ve written about this several times; the long version in MORE magazine, and, even longer, in a collaborative investigation between the Food and Environment Reporting Network, the Atlantic, and ABC News.
The short version is this: Up to 8 million urinary-tract infections occur in the United States each year, and each year, a growing and significant proportion—hard to measure, but probably at least 10 percent, or 800,000—are antibiotic-resistant.
This has been happening with such frequency that it has actually changed medical practice. Medical specialty societies have been advising doctors for several years now that they should always do a test to determine which antibiotic will work for a UTI, rather than prescribing based on a standard checklist.
But only a few researchers have investigated why that tide of resistance is rising. What they have found is that these resistant UTIs infections are not random and singular, but instead constitute a focused epidemic, caused by particular sets of E. coli that bear the same resistance signatures as ones found in meat animals given antibiotics.
This idea has had difficulty gaining traction, because UTIs are usually dismissed as a minor problem, something that causes a few days of annoyance and requires a few days of antibiotics to fix. (And, not coincidentally, because they overwhelmingly happen to women.) But when UTIs go untreated—which is effectively what happens when the antibiotic administered for them doesn’t work —they climb up the urinary system from the bladder, into the kidneys, and thence into the bloodstream.
At that point, the minor problem becomes literally life-threatening. And resistant UTIs are not only a problem for the individual sufferer: They also pose the possibility of infecting others, if the original victim goes into a hospital for treatment and carries the resistant organism unrecognized in their system.
One reason it has taken so long to recognize this problem is that there is no single surveillance network that could capture all the resistance patterns in all those UTI sufferers, and compare them. There is also the problem of belief: It’s just difficult to imagine that something as minor as a UTI could be the signal of something as grave as a widespread epidemic.
Because of that, the MCR finding in Pennsylvania could end up being fortunate—no only for detecting a grave development early, but also for shining a light on a danger that has been growing, unrecognized, for a while.