Died from an Antibiotic/Antimicrobial Resistant Infection

Please add the profiles of those who have died as a result of an antibiotic resistant infection.

Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat patients who have infectious diseases. Since the 1940s, these drugs have greatly reduced illness and death from infectious diseases. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective and the bacterial infections again becoming a threat. The antibiotic resistance crisis has been attributed to the overuse and misuse of these medications, as well as a lack of new drug development by the pharmaceutical industry due to reduced economic incentives and challenging regulatory requirements.

Antibiotic resistance occurs when the medication loses its ability to kill bacteria. As a result, the organisms continue to grow and cause infection, even in the presence of the antibiotic. The bacteria, not humans or animals, become antibiotic-resistant.

Some bacteria are naturally resistant to certain types of antibiotics, but most become resistant through a natural genetic mutation or by acquiring resistance genes from other bacteria. When bacteria mate, they transfer their resistance traits. Because bacteria can acquire many resistance traits over time, they can become resistant to different types of antibiotics.
  Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.

Key facts

• Antibiotic resistance is one of the biggest threats to global health, food security, and development today.
• Antibiotic resistance can affect anyone, of any age, in any country.
• Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
• A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.
• Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality.

Causes:

Reasons for the widespread use of antibiotics in human medicine include:

• increasing global availability over time since the 1950s
• uncontrolled sale in many low or middle income countries, where they can be obtained over the counter without a prescription, potentially resulting in antibiotics being used when not indicated. This may result in emergence of resistance in any remaining bacteria.

Other causes include:

• Antibiotic use in livestock feed at low doses for growth promotion is an accepted practice in many industrialized countries and is known to lead to increased levels of resistance.
• Releasing large quantities of antibiotics into the environment during pharmaceutical manufacturing through inadequate wastewater treatment increases the risk that antibiotic-resistant strains will develop and spread.
• It is uncertain whether antibacterials in soaps and other products contribute to antibiotic resistance, but antibacterial soaps are discouraged for other reasons.

Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. A growing list of infections – such as pneumonia, tuberculosis, blood poisoning, gonorrhoea, and foodborne diseases – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.

From: The New York Times-Infection Killed 19,000 in 2005, Study Says. by Kevin Sack, 16 Oct 2007

Nearly 19,000 people died in the United States in 2005 after being infected with a virulent drug-resistant bacterium that has spread rampantly through hospitals and nursing homes, according to the most thorough study to be conducted of the disease’s prevalence.

• The study, which was published today in The Journal of the American Medical Association, suggests that invasive infections with methicillin-resistant Staphylococcus aureus, or M.R.S.A., may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens. If the mortality estimates are correct, the number of deaths associated with M.R.S.A. each year would exceed those attributed to HIV/AIDS, Parkinson’s disease, emphysema or homicide.
• The study also concluded that 85 percent of invasive M.R.S.A. infections are associated with health-care treatment. Previous research had indicated that many hospitals and long-term care centers have become breeding grounds for M.R.S.A. because bacteria may be transported from patient to patient by doctors, nurses and unsterile equipment.
• Though the C.D.C. estimates that M.R.S.A. represents only 10 percent to 20 percent of all infections acquired in health-care settings, the bacterium is feared for its opportunism and deadliness.
• First isolated in the United States in 1968, it is resistant to a number of antibiotics and can cause infections of surgical sites, the urinary tract, the bloodstream and the lungs, leading to extensive and expensive hospital stays. The bacteria can be brought unknowingly into hospitals and nursing homes by patients who show no symptoms, and then takes advantage of weakened immune systems, incisions and wounds.

Seven of the scariest drug-resistant infections:

• 1) Clostridium Difficile (C. diff) - causes over 450,000 gut infections in the US each year, according to a study published in the New England Journal of Medicine. This bug can take over the gut when normal bacteria residents are booted out by antibiotics. The infection can cause painful cramping, inflammation, and diarrhea.
• 2) Carbapenem-Resistant Enterobacteriaceae (CRE) - Enterobacteriaceae are a family of bacteria that include pathogens found in the digestive tract as well as the environment, including Escherichia coli (E. coli), Salmonella, and Shigella, among others. The bacteria can live in the intestines without causing disease. But if food or water is contaminated by certain strains of Enterobacteriaceae, they can cause food poisoning or gastroenteritis, the main symptoms of which are vomiting and diarrhea. It can sometimes spread outside the gut and infect the lungs, skin, bladder, and bloodstream, and are resistant to a class of antibiotics, such as those similar to penicillin, often used as a “last resort” against resistant bacteria in the enterobacteriaceae family. E. coli and Klebsiella are two more commonly known types of enterobacteriaceae.
• 3) Drug-Resistant Neisseria Gonorrhoeae - a group of sexually transmitted bacteria that cause urinary and reproductive tract infections, rectal infections, and can lead to infertility in men and women if left untreated. According to the CDC, the drugs available for treating these infections are dwindling.
• 4) Methicillin-Resistant Staphylococcus Aureus (MRSA) - Up to two percent of people carry MRSA in their noses or on their skin. However, if it spreads into an open wound, or the immune system can’t control it, then MRSA can cause severe skin infections and deadly bloodstream infections. Sometimes MRSA stays on the skin, but it can invade the body, causing potentially life-threatening infections in bones, joints, the heart, and the lungs.
• 5) Streptococcus Pneumoniae - is most commonly spread through coughing, can cause ear and sinus infections, pneumonia, and meningitis. This type of bacteria is spread through coughing, sneezing, and close contact with an infected person. Symptoms depend on the part of the body infected. They can include fever, cough, shortness of breath, chest pain, stiff neck, confusion and disorientation, sensitivity to light, joint and ear pain, chills, sleeplessness, and irritability. It can cause hearing loss, brain damage, and death if the infection is severe.
• 6) Drug-Resistant Malaria - is caused by a parasite that is transferred to humans through mosquito bites. There are five different parasites that can cause malaria. Three of those parasites have now developed resistance to antimalarial drugs. Malaria causes fever, fatigue, nausea, and vomiting. Malaria is the most deadly to children under the age of five. Though cases and deaths have dropped significantly in the last decade, the disease still caused approximately 584,000 deaths worldwide in 2013.
• 7) Multi-drug resistant (MDR) and extensively drug resistant (XDR) Tuberculosis - is the second biggest infectious cause of death worldwide, according the World Health Organization. The CDC estimates over 1,000 drug-resistant tuberculosis cases occurred in the US in 2013. Worldwide, MDR cases have reached over 480,000 and only about half of patients with MDR tuberculosis can be cured. Tuberculosis, which is spread by coughing and sneezing, is most dangerous for people with weakened immune systems in settings where many people are crowded together, like nursing homes, homeless shelters, and prisons.

In 2013, CDC published a report outlining the top 18 drug-resistant threats to the United States. These threats were categorized based on level of concern: urgent, serious, and concerning.

• Urgent Threats include: Clostridium Difficile (CDIFF), Carbapenem-Resistant Enterobacteriaceae (CRE) and Neisseria gonorrhoeae
• Serious Threats include: Multidrug-Resistant Acinetobacter, Drug-Resistant Campylobacter, Fluconazole-Resistant Candida, Extended Spectrum Enterobacteriaceae (ESBL), Vancomycin-Resistant Enterococcus (VRE), Multidrug-Resistant Pseudomonas Aeruginosa, Drug-Resitant Non-Typhoidal Salmonella, Drug-Resitant Salmonella Serotype Typhi, Drug-Resistant Shigella, Methicillin-Resistant Staphylococcus Aureus (MRSA), Drug-Resistant Streptococcus Pneumoniae, and Drug-Resistant Tuberculosis.
• Concerning Threats include: Vancomycin-Resistant Staphylococcus Aureus, Erythromycin-Resistant Group A Streptococcus, and Clindamycin-Resistant Group B Streptococcus.

History of Antibiotics

• The management of microbial infections in ancient Egypt, Greece, and China is well-documented.
• The modern era of antibiotics started with the discovery of penicillin by Sir Alexander Fleming in 1928.
• Antibiotics were first prescribed to treat serious infections in the 1940s.
• Penicillin was successful in controlling bacterial infections among World War II soldiers.
  • However, shortly thereafter, penicillin resistance became a substantial clinical problem, so that, by the 1950s, many of the advances of the prior decade were threatened.
  • In response, new beta-lactam antibiotics were discovered, developed, and deployed, restoring confidence. However, the first case of methicillin-resistant Staphylococcus aureus (MRSA) was identified during that same decade, in the United Kingdom in 1962 and in the United States in 1968.
• From the late 1960s through the early 1980s, the pharmaceutical industry introduced many new antibiotics to solve the resistance problem, but after that the antibiotic pipeline began to dry up and fewer new drugs were introduced.
• Unfortunately, resistance has eventually been seen to nearly all antibiotics that have been developed. As a result, in 2015, many decades after the first patients were treated with antibiotics, bacterial infections have again become a threat.
• The phenomenon of antimicrobial resistance caused by overuse of antibiotics was predicted by Alexander Fleming who said "The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to nonlethal quantities of the drug make them resistant.

For those living with antibiotic resistant infections, please see: Consumer Reports - The One Doctor You Need to See If You Get an Antibiotic Resistant Infection. by Louren F Friedman, 15 Mar 2018

Notables who died from an antibiotic resistant infection

Hugh Hefner (1926-2017) -- Health - Hugh Hefner Had a Drug-Resistant E. Coli Infection. Here’s What You Should Know. by Sarah Klein, October 03, 2017

Resources & Additional Reading:

• CDC - Antibiotic / Antimicrobial Resistance (updated 29 Mar 2018)
• CDC - Antibiotic / Antimicrobial Resistance, Biggest Threats. (updated 27 Feb 2018)
• CDC - Antibiotic Resistance Threats in the United States, 2013 (last updated: 9 Apr 2018)
• The New York Times - Infection killed 19,000 in 2005, Study Says. by Kevin Sack, 16 Oct 2007
• The Atlantic - Health - A Woman Was Killed by a Superbug Resistant to all 26 American Antibiotics. by Sarah Zhang, 13 Jan 2017
• Smithsonian.com - Superbugs Could Become a Top Cause of Death by 2050. by Colin Schultz, 11 Dec 2014
• World health Organization - Antimicrobial resistance. 15 Feb 2018
• WHO - Antibiotic resistance. 5 Feb 2018
• National Post - Antibiotic-resistant bacteria now a common cause of death, sickening millions a year: US report. 17 Sep 2013
• Everyday Health - 7 Scary Drug-Resistant Infections. by Amanda B Keener
• NYU Langone Health - Types of Antibiotic-Resistant Infections
• Aftermath - Drug Resistant Bacterial Infections
• NCBI - The Antibiotic Resistance Crisis. by C Lee Ventola, MS, Apr 2015
• Wikipedia - Antimicrobial resistance

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