Understand how we got here — and how to move forward.


January 17, 2017

Woman killed by superbug resistant to all US-approved antibiotics

Daily Briefing

A Nevada woman died last September from a superbug infection resistant to all antibiotics approved in the United States, CDC reported Thursday in the Weekly Morbidity and Mortality Report.

Case details

The patient was a woman in her 70s who had arrived in the United States following an extended stay in India. While in India, the woman had been hospitalized several times for a broken femur and subsequent bone infection. Her most recent hospitalization in India was in June 2016.

According to STAT News, drug-resistant bacteria are more common in India than they are in the United States.

The woman went to a Reno-area hospital on Aug. 18, 2016, for systemic inflammatory response syndrome, which CDC said was likely due to an infected hip seroma. Testing the next day found that the woman had been infected with Klebsiella pneumoniae, a carbapenem-resistant Enterobacteriaceae (CRE). CRE is the name for bacteria that typically live in the gut and are resistant to carbapenems, a "last-line of defense used when other antibiotics fail," Helen Branswell reports for STAT News.

The woman was treated in isolation at the hospital, with the care team using infection control measures to avoid spreading the superbug in the hospital. She died in early September from septic shock.

Pathogen resistant to all available antibiotics in the US

Testing at the Reno-area hospital found that the infection was resistant to all 14 drug options available on site, according to Lei Chen, a senior epidemiologist with Washoe County Health District and author of the CDC report. The hospital sent a sample to CDC in Atlanta for additional testing, which revealed that the infection was resistant to 26 antibiotics—all of the options available in the United States.

Other U.S. residents have become infected with pan-resistant bacteria—but STAT News reports that it is rare.

Scientists found that the bacteria that killed the woman was relatively susceptible to fosfomycin. But that antibiotic is not approved the United States to treat her kind of infection. While other countries have approved fosfomycin in intravenous formulations, the United States has approved it only in an oral formulation for uncomplicated cystitis.

"It was tested against everything that's available in the United States … and [the treatments were] not effective," said Alexander Kallen, a medical officer in CDC's division of health care quality promotion.

An isolate of the pathogen tested positive for New Delhi metallo-beta-lactamase (NDM), which has been found in other pan-resistant superbugs. However, the authors of the report said health officials have been monitoring the Reno area for CRE since 2010 and have not spotted any other instances of NDM CRE over that time.

CDC recommendations

In the review of the case, CDC investigators said health care facilities should obtain patients' histories of overseas health care exposures and consider screening patients for CRE if they report having visited a health care provider abroad.

In addition, CDC urged hospitals to implement strict infection control procedures and contact tracing when they detect organisms with:

  • NDM;
  • mcr-1, another antibiotic-resistant gene; or
  • Pan-resistance to all drug classes.

'Harbinger of future badness'

Physicians and scientists who study the spread of antibiotic resistance expressed concern about the case and said it should spur renewed focus on a response plan.

James Johnson, a professor of infectious diseases medicine at the University of Minnesota and a specialist at the Minnesota VA Medical Center, said, "I think this is the harbinger of future badness to come."

Lance Price, head of the Antibiotic Resistance Action Center at George Washington University, said, "If we're waiting for some sort of major signal that we need to attack this internationally, we need an aggressive program, both domestically and internationally to attack this problem, here's one more signal that we need to do that" (Branswell, STAT News, 1/12; Gever, MedPage Today, 1/12; Zhang, The Atlantic, 1/13; Chen, Morbidity and Mortality Report, 1/13).

Eight steps for successful change initiatives

Performance improvement seems simple at first: identify a problem, then take steps to solve it. But in practice, many organizations struggle to get change initiatives off the ground, often due to four pitfalls: lack of leadership attention, poor work planning, rocky rollout, and insufficient follow-up.

Our overview synthesizes years of Advisory Board research and experience into a single road map for performance improvement and defines eight steps crucial to avoiding these major pitfalls in any change initiative.

Download the brief

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.