No, this isn’t the start of the antibiotic apocalypse, just bad reporting
No, this isn’t the start of the antibiotic apocalypse, just bad reporting

          
          
The only real first in this case is that it’s the first time mcr-1-based colistin resistance has shown up in a US patient.
While, again, this isn’t exactly good news, it’s not catastrophic. There are several last-resort antibiotics, and doctors can try different combinations and strengths of prescriptions before an infection may be deemed untreatable.
Next is the confusing CRE connection
The CNN headline, which has now been updated, initially incorrectly identified the colistin resistant bacteria as a CRE. Other articles have brought this term up as well.
CRE stands for carbapenem-resistant Enterobacteriaceae. The Enterobacteriaceae are a big family of bacteria that include some harmless ones and some notable pathogenic ones, including Salmonella, E.coli, Klebsiella, and Shigella.
Carbapenem resistance is a big concern because it has been rising steadily in recent years, and CRE infections can lead to death 50 percent of the time. For this reason, CRE infections have been dubbed by some as “nightmare” cases.
However, the bacteria reported today is not a CRE. While it is an E. coli strain, it’s in the Enterobacteriaceae family and has a whopping 15 types of antibiotic resistance genes—genes for carbapenem resistance were not among them. There were several other antibiotics that the strain was still sensitive to as well.
Here's the quick take-away
Thursday’s report of a mcr-1-based colistin-resistant bacterial infection in a US patient is concerning, but unsurprising. The plasmid based resistant gene threatens to spread to other bacteria, potentially to ones that are already resistant to last resort drugs, such as CRE. However, the trajectory of mcr-1's emergence and its contribution to drug resistant infection trends is not yet clear. For now, the case serves mostly to highlight the ongoing crisis of rising antibiotic resistance and furthers the need for better stewardship of old antibiotics and development of new ones.
Antimicrobial Agents and Chemotherapy, 2016. DOI: 10.1128/AAC.01103-16  (About DOIs).


          
                  