Katie Chiotos, MD, is currently a fellow in the Division of Infectious Diseases at the Children's Hospital of Philadelphia and will be completing a dual fellowship in both pediatric infectious diseases and critical care medicine.  She studied biology and art history at the College of William and Mary, Williamsburg, Va., and went on to graduate with a medical degree from  George Washington University, Washington, DC.  Chiotos completed her residency training in pediatrics at the Children's Hospital of Philadelphia.  Her research interests include management of sepsis and septic shock, as well as quality improvement. Disclosure: Chiotos reports no relevant financial disclosures.

New treatment strategies needed for drug-resistant organisms

At the beginning of my shift, Sam* was a relatively healthy ICU patient with no prior medical problems, admitted the night before with what we thought was an uncomplicated community-acquired bacterial pneumonia. Over the next 12 hours, however, things changed dramatically.

First his breathing became more labored and his oxygen saturations fell, so he was intubated and placed on a ventilator. His blood pressure became dangerously low, so an infusion of epinephrine was started. A repeat X-ray showed that a large pleural effusion had developed, so a chest tube was placed and pus was evacuated from his chest. His mother stood at his bedside, surprisingly calm despite her son’s critical condition; that is, until we informed her that her son’s infection was caused by MRSA. “How could he have gotten MRSA?  Is he going to die?” she cried out as she sobbed uncontrollably. 

Though I like many physicians grow tired of the popular media’s portrayal of so-called “super bugs” like MRSA and the hysteria it seems to incite in our patients, I increasingly share the fear expressed by families such as this one when they are told their child is infected with a resistant organism. MRSA is perhaps the best known example thanks to extensive media coverage, but other resistant organisms such as carbapenem-resistant Enterobacteriaceae, including Klebsiella producing carbapenemase organisms, vancomycin-resistant Enterococcus, and vancomycin-intermediate and resistant Staphylococcus aureus are arguably larger threats given the paucity of available antibiotics to treat these often aggressive infections.  

A multi-faceted strategy is desperately needed if we are to combat the growing threat of these drug-resistant organisms, as laid out by the CDC and supported by the Infectious Diseases Society of America.  Prevention, though strictly enforced infection control practices and judicious antimicrobial use, are clearly paramount to protecting patients and halting the spread of these dangerous infections. Treatment, however, is uniquely challenging, given that there are not only no antibiotics currently available to treat some of these organisms, but that there are very few new drugs in the pipeline. The reasons for this are multiple, and include the technical difficulty in developing new antibiotics, the relatively low return on investment for a pharmaceutical company to develop an antibiotic for a (thankfully) rare infection, and the difficulty in navigating the FDA approval process. To me, this is where the true public health crisis lies. 

Fortunately, Sam’s infection was successfully treated with vancomycin and he is safely home with his family. I wonder, however, how soon it will be until I will see a child with an infection for which there is no treatment.

*Name changed