Minnesota: Bacterial Resistance Prompts Concern

Ruzanna Harutyunyan's picture

Health officials in Minnesota say they are seeing increasing evidence of antibiotic resistance in disease-causing bacteria in the state, prompting a reminder to health care providers and patients about the importance of using antibiotics carefully and appropriately.

A report in this week's New England Journal of Medicine details the finding by health officials in Minnesota, North Dakota and the Centers for Disease Control in Atlanta of an antibiotic-resistant strain of bacterium, Neisseria meningitidis, that causes meningococcal disease. In a related occurrence, the Minnesota Department of Health (MDH) on Tuesday sent an alert to infection control professionals and health care providers regarding a very resistant strain of Klebsiella pneumoniae bacteria.

The bacteria N. meningitidis can cause meningitis, sepsis, pneumonia and joint infections. These infections can be life-threatening. The resistant strain of N. meningitidis was discovered during an investigation and follow-up of three cases of the disease in 2007 (Jan. '07-Jan. '08). The cases, two in western Minnesota and one in North Dakota, were not related or linked, (except that the first case attended a daycare where an adult worker died of probable meningococcal disease in 2006). All three had the same strain of the bacterium and all proved to be resistant to ciprofloxacin, the antibiotic most often recommended for preventing infections in adult close contacts of infected persons. These were the first strains of N. meningititidis in North America found to be resistant to ciprofloxacin, a commonly used antibiotic.

"This is extremely concerning because ciprofloxacin-resistance in a related bacteria, Neisseria gonorrhoeae, rose very quickly over a few years, and ciprofloxacin is no longer recommended to treat gonococcal infections" said Ruth Lynfield, state epidemiologist with MDH. "This finding further stresses the importance of using antibiotics judiciously. We've lost an important tool here for fighting disease causing bacteria and we need to preserve the effectiveness of the tools we have. That's why we need to be extremely careful how we use antibiotics."

Scientists contend that overuse and misuse of antibiotics contributes to bacteria's ability to adapt and mutate to resistant strains in order to survive. Details of the investigation and a discussion of how the bacteria may have become resistant can be found in the report at The New England Journal of Medicine.

After discovery of the resistant strain, the state health departments in North Dakota and Minnesota advised health care providers in eastern North Dakota and western Minnesota to use alternative antibiotics as preventive treatment for people who had close contact with someone diagnosed with meningococcal disease. In addition, the CDC recommended increased nationwide surveillance for antibiotic-resistant meningococcal bacteria.


In another instance, a highly resistant strain of Klebsiella pneumoniae, a disease-causing bacterium, was recently identified in Minnesota, health officials reported. This strain, called carbapenemase- producing Klebsiella pneumoniae (KPC) is resistant to almost all classes of antibiotics. This type of resistance is especially concerning because it can spread to other similar bacteria making them also resistant. "This is the first time we've identified KPC in Minnesota," said Lynfield. "However, KPC has been responsible for hospital outbreaks in other parts of the country where infections caused by this strain were associated with increased severity of illness and death. In addition, these bacteria have been shown to spread readily between patients."

While resistant N. meningitidis and KPC are very different pathogens, their emergence demonstrates the problem presented by increasing antibiotic resistance, health officials said. Preserving the effectiveness of antibiotics is essential – and everyone (not just clinicians) has a responsibility to use them appropriately.

Minnesota health officials recommend the following:

* Patients should not insist on antibiotics. Let health care providers decide if an antibiotic is needed to treat an illness.

* Many respiratory infections such as influenza or acute bronchitis are caused by viruses. Antibiotics treat bacterial infections - not infections caused by viruses.

* Clinicians should increase efforts to diagnose the cause of infections and tailor treatment to the specific illness.

* Infection prevention and control measures in health care, including acute care and long-term care facilities, are very important.

* Practice basic infection prevention measures such as good hand washing, covering your cough, staying home and away from others when you're sick, and getting recommended vaccines.



Sometimes, Death Is Good….. For A Vicious Unicellular Microorganism. There are a variety of different types of foreign bacterial infections one can get from many different sources, yet some are more common than others. If they are not beneficial for your physiology, they all should die in order to restore your health. Bacteria are a simple life form, yet are incredibly productive and efficient. As with other life forms, it exists to reproduce, and does so about every hour, and evolves and adapts to its environment as needed. To do this, it fully utilizes all available resources and energy to develop the protein that is essential for its survival, and bacteria have the ability to adapt as needed to assure this happens. It needs exactly 7 genes to produce the essential ribosomes for this to occur. Any more or less genes than 7, the bacteria is not maximizing its efficiency to survive and reproduce. Amazing. Strept infections are caused by what are called gram positive bacteria, and are the most common bacteria that infect others. Staph bacterial invasions are gram positive as well, yet it is the MRSA, Methicillin Resistant Staff Aureous bacteria of this type often are very difficult to treat normally when a patient suffers from their damage from being invaded by these bacteria. Another difficult situation is when a patient is infected by VRE, Vancomycin Resistant Enterococci, as well. These MRSA and VRE pathogenic or disease causing bacteria are the ones that are the most clinically concerning for the health care provider. In most cases, such bacteria invade a resident of a medical institution, and have proved to result in very dangerous infections. If so, they are called nosocomial infections, and such infections are not limited to resistant strains of bacteria. Greater than 5 percent of nosocomial infections are determined to be MRSA infections, others have determined. This results in about 100,000 serious hospital infections, as well as about 20,000 deaths from MRSA infections annually. Group A strep infections can cause diseases such as strep throat and pneumonia. Since there are several types of bacteria, a diagnostic test called a culture and sensitivity is usually performed to assure the correct antibiotic is selected for treatment, as the bacteria are identified with this method. Typically, fluid from the area suspected of being infected is obtained from the patient suspected to have an infection and smeared on what is called a petrie dish. And then these dishes are incubated for 2 to 3 days. Gram positive bacteria stain during this process a dark violet or blue. Gram negative bacteria would be pink in color, and are capable of harm as well to a human being. When the culture is complete, technology offers recommendations on the appropriate class or brand of antibiotic for this bacteria present in another person- presuming the bacteria will not be resistant to the antibiotic recommended, as this happens on occasion. Usually, classes of antibiotics that are used to treat gram positive strep infections that are not VRE or MRSA are cephalosporins, macrolides, or general penicillins. If the microbe that is causing the infection is resistant to the antibiotic from such classes that are administered to the infected patient, other options should be considered. With two antibiotics in particular, which are methicillin and vancomycin, which is the case with VRE and MRSA bacteria, then there are other more aggressive antibiotics that will be chosen for this patient. Such brands and types of antibiotics for MRSA and VRE bacteria include Zyvox, which has both IV and oral dosage options. There are also other antibiotics, such as Cubicin. However these antibiotics for antibiotic resistant bacteria are given usually due to infections that have progressed to a more serious nature within a patient infected in such a way. Progressive medical conditions include sepsis, or blood infection, osteomyelitis, or bone infection, or Pneumonia, which is a serious lung infection. A hospital stay is normally required with such patients, as the last antibiotics mentioned for MRSA and VRE bacterial infections are given by IV administration initially for several days, if not several weeks. There are numerous classes and types of antibiotics available, yet bacterial resistance to most of these antibiotics constantly remains serious concern for the health care provider, and the infected patient. With MRSA at the top of the list of concerns for the health care providers, this concern continues to progress, unfortunately. Medical institutions should possibly consider quarantine for those patients at their locations that have been determined to be infected with the MRSA bacteria. Dan Abshear http://www.cdc.gov/ncidod/dhqp/ar_mrsa_spotlight_2006.html