Detroit health professionals urge the community to act and address the dangers of antimicrobial resistance
Wayne State University - Office of the Vice President for Research
DETROIT — Wayne State University's Center for Emerging and Infectious Diseases (CEID) is launching its participation in World AMR Awareness Week with an urgent message: the growing threat of antimicrobial resistance requires immediate community action, so it is critical to educate, advocate, and act now.
Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial agents. Because of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of spreading various diseases that may lead to severe illness or even death.
"Antimicrobial resistance isn't just a future threat—it's a present crisis affecting our Detroit community right now," said Marcus Zervos, M.D., co-director of CEID. "When common infections become resistant to treatment, routine medical procedures become increasingly dangerous. We're seeing this challenge firsthand in our hospitals."
World AMR Awareness Week is a global campaign to raise awareness and understanding of AMR and promote best practices to address it. It goes from Monday, Nov. 18 to Sunday, Nov. 24. CEID will lead initiatives highlighting this year's theme, “Educate, Advocate, Act Now.”
CEID officials say that Detroit has become an important community in the observation and response to AMR, with several new types of resistant microorganisms first being observed in the southeast Michigan area.
"In Detroit's healthcare facilities, we're encountering more cases where standard antibiotics are failing,” said Teena Chopra, M.D., M.P.H., an infectious diseases expert and co-director at CEID. “This puts our most vulnerable populations at heightened risk."
Increased use and misuse of antimicrobials across sectors and other microbial stressors, such as pollution, create favorable conditions for microorganisms to develop resistance. Bacteria in water, soil and air, for example, can become resistant to common antibiotics following contact with resistant microorganisms. Human exposure to AMR in the environment can occur through contact with polluted waters, contaminated food, inhalation of fungal spores, and other pathways that contain antimicrobial resistant microorganisms.
Health experts have several suggestions to help prevent AMR: Only use antibiotics when prescribed by healthcare professionals, complete the full course of prescribed antibiotics, practice regular hand hygiene, keep vaccinations up to date, properly dispose of unused medications, and learn about infection prevention. CEID experts want the public to understand that antibiotics are not just another medication; they're a precious resource that must be protected through informed usage.
"The public needs to be aware of the potential presence of drug-resistant bacteria in our food supply," said Paul Kilgore, M.D., M.P.H., F.A.C.P, a professor and director of research for the Department of Pharmacy Practice in Wayne State University and co-director of CEID. "As antimicrobial resistance increases globally, some bacteria are becoming resistant to multiple antibiotics, creating dangerous 'superbugs' that pose significant risks to public health. It is important that people adopt responsible practices in their daily lives for using antibiotics and other antimicrobial agents. Important steps include using antibiotics only when prescribed, avoid sharing antibiotics or using them for non-infectious conditions, vaccinate to prevent disease, use good hygiene by washing your hands regularly, practice safe food handling, and educate others about the importance of using antibiotics responsibly and the risks of antimicrobial resistance.”
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Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit research.wayne.edu.
Wayne State University’s research efforts are dedicated to a prosperity agenda that betters the lives of our students, supports our faculty in pushing the boundaries of knowledge and innovation further, and strengthens the bonds that interconnect Wayne State and our community. To learn more about Wayne State University’s prosperity agenda, visit president.wayne.edu/prosperity-agenda.
Genomic surveillance studies reveal circulation of multidrug-resistant Enterobacterales in Europe
Two studies indicate warning signs about spread of bacteria resistant to the same group of antibiotics (carbapenems) in both healthcare and community settings across Europe.
European Centre for Disease Prevention and Control (ECDC)
image:
Phylogenetic tree of Escherichia coli ST131 isolates, including its single locus variants included in the genomic relatedness
analysis, EU/EEA and outside, 2005–2024 (n = 691).
Credit: Eurosurveillance journal
Patients seeking treatment in hospital or other healthcare facilities can be particularly vulnerable for infections they acquire during their stay, especially if the infections are difficult to treat because they are resistant to commonly used drugs. For example, Carbapenem-resistant Enterobacterales (CRE) are known to particularly affect hospitalised patients. [1]
Two studies published in Eurosurveillance marking World AMR Awareness Week from 18 to 22 November 2024, analysed new data on spread of such CRE, namely Escherichia coli sequence type (ST)131 producing various carbapenemases and New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Providencia stuartii to inform potential public health action.
Escherichia coli lineage with emerging resistance pattern spreads in the community
In a rapid communication, Kohlenberg et al. assessed genomic and epidemiological data from 17 EU/EEA countries and observed an emergence of Escherichia coli that produces carbapenemases.
Worldwide, E. coli is the pathogen associated with most deaths attributable to antimicrobial resistance [2] and the specific type of E. coli that the authors investigated in their study (ST 131) has been detected across the world and is frequently associated with multidrug-resistance.
Kohlenberg et al. analysed the sequencing and epidemiological data of almost 600 E. coli ST131 isolates provided by national reference laboratories from Austria, Belgium, Czechia, Denmark, Finland, France, Hungary, Ireland, Germany, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Portugal, Slovenia and Sweden. [3]
Detection of E. coli ST131 isolates producing carbapenemases increased over time. One group of isolates stood out for potential association with urinary tract infections in the community inferred from the relatively low median age of patients (57 years), a high proportion of female patients and the frequent detection of isolates from urine samples. The authors note that “community-acquired urinary tract infections might only represent the tip of the iceberg in terms of patient colonisation in the community”.
While Kohlenberg et al. acknowledge they did not analyse a random population of E. coli ST131 but pre-selected isolates from the reference laboratories which probably resulted in an isolate collection with a higher likelihood for co-carriage of other resistance markers, they argue that the results of their study across 17 EU/EEA countries “sends another warning about the worsening epidemiological carbapenemase-producing Enterobacterales situation in the EU/EEA. Further spread of E. coli carrying carbapenemase genes would mean that carbapenems could no longer be consistently effective for empiric treatment of severe E. coli infections.”
Sustained transmission of carbapenem-resistant Providencia stuartii in the healthcare system
One type of CRE which has been very rare in Europe thus far – New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Providencia stuartii – has now been detected in several hospitals in Romania.
In their genomic investigation, Linkevicius et al. [4] looked at how NDM-1-producing P. stuartii is spreading in hospitals with the aim to generate timely information to control any further transmission.
In their study, the authors analysed 74 P. stuartii samples they received from six hospitals across Romania. Most (n=72/74) of the retrieved isolates were related to a reported infection among patients, such as lower respiratory tract bloodstream or urinary tract infections. The authors categorised the majority of the infections as healthcare-associated, i.e. the patients acquired them in a hospital or other healthcare setting. [3]
Given their resistance to several antibiotic classes like penicillins, cephalosporins and carbapenems, 90% of the tested isolates in this study were categorised as multidrug-resistant. In their investigation, Linkevicius et al. identified four multi-hospital clusters of such resistant isolates detected over a year. This indicates sustained transmission within the Romanian healthcare system over a longer period.
Putting their study results into international context by comparing with data from other countries, the authors could also connect the specific lineage of P. stuartii detected in Romania to isolates found in other countries, i.e. Bulgaria, France, Germany, Ireland, the Netherlands, Switzerland, the United Kingdom and the United States of America.
They conclude that “sustained transmission in hospitals in Romania and the international spread point to high risk of further transmission of NDM-1-producing P. stuartii in healthcare settings. Enhanced infection prevention and control measures should be put in place as soon as cases are detected in healthcare facilities.”
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References/notes to editors:
[1] Enterobacterales are a group of bacteria (germs) that are a normal part of the human and animal gut but can also cause infections. Carbapenem-resistant Enterobacterales (CRE) are germs resistant to one or several antibiotics called carbapenems. See: https://www.cdc.gov/cre/about/index.html
[2] Kohlenberg Anke, Svartström Olov, Apfalter Petra, Hartl Rainer, Bogaerts Pierre, Huang Te-Din, Chudejova Katerina, Malisova Lucia, Eisfeld Jessica, Sandfort Mirco, Hammerum Anette M, Roer Louise, Räisänen Kati, Dortet Laurent, Bonnin Rémy A, Tóth Ákos, Tóth Kinga, Clarke Christina, Cormican Martin, Griškevičius Algirdas, Khonyongwa Kirstin, Meo Marie, Niedre-Otomere Baiba, Vangravs Reinis, Hendrickx Antoni PA, Notermans Daan W, Samuelsen Ørjan, Caniça Manuela, Manageiro Vera, Müller Vilhelm, Mäkitalo Barbro, Kramar Urška, Pirs Mateja, Palm Daniel, Monnet Dominique L, Alm Erik, Linkevicius Marius. Emergence of Escherichia coli ST131 carrying carbapenemase genes, European Union/European Economic Area, August 2012 to May 2024. Euro Surveill. 2024;29(47)
Available from: https://doi.org/10.2807/1560-7917.ES.2024.29.47.2400727
[3] Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55. Available from: http://dx.doi.org/10.1016/S0140-6736(21)02724-0 PMID:35065702
[4] Linkevicius Marius, Witteveen Sandra, Buzea Mariana, Flonta Mirela, Indreas Marina, Nica Maria, Székely Edit, Tălăpan Daniela, Svartström Olov, Alm Erik, Palm Daniel, Monnet Dominique L, Hendrickx Antoni PA, Kohlenberg Anke, Popescu Gabriel Adrian. Genomic surveillance detects interregional spread of New Delhi metallo-beta-lactamase-1-producing Providencia stuartii in hospitals, Romania, December 2021 to September 2023. Euro Surveill. 2024;29(47):pii=2400587. Available from: https://doi.org/10.2807/1560-7917.ES.2024.29.47.2400587
[5] Healthcare-associated infections are infections acquired by patients during their stay in a hospital or another healthcare setting. Although some of these infections can be treated easily, others may more seriously affect a patient’s health, increasing their stay in the hospital and hospital costs, and causing considerable distress to these patients.
The most frequently reported types of healthcare-associated infections are respiratory tract infections, surgical site infections, urinary tract infections, bloodstream infections and gastro-intestinal infections. See: https://www.ecdc.europa.eu/en/healthcare-associated-infections
Journal
Eurosurveillance
Method of Research
Data/statistical analysis
Article Title
Emergence of Escherichia coli ST131 carrying carbapenemase genes, European Union/European Economic Area, August 2012 to May 2024
Article Publication Date
21-Nov-2024
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