Searching For Superbugs: The Lab Looking For The Next Big Threat

Searching for Superbugs: The Lab Looking for the Next Big Threat - NBC News
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HEALTH MAY 31 2016, 6:34 AM ET
Searching for Superbugs: The Lab

Looking for the Next Big Threat
by MAGGIE FOX
SILVER SPRING, Md. It was a Friday in mid-May, and Erik Snesrud was
checking out the first batch of samples under a new directive.
The order had just come in to look for a new gene called mcr-1 that had
already achieved global notoriety among microbiologists. It gives germs the
ability to withstand the effects of colistin, a last-resort antibiotic used to save
the lives of people infected with serious superbugs.
Erik Snesrud of the Walter Reed Army Institute

of Research checks bacterial gene sequences.
Maggie Fox / NBC News
The sample was loaded into one of

the super-fast gene sequencers at
the lab inside the bowels of the
Walter Reed Army Institute of
Research. The small team at the
Multidrug Resistant Organism
Repository and Surveillance Network
(MRSN) lab specializes in testing
germs for antibiotic resistance,
which has become the scourge of
hospitals all over the world.
The results were back in minutes. One of the samples some E. coli bacteria
taken from a woman with a urinary tract infection in Pennsylvania carried the
gene.
Snesrud knew he was going to lose his weekend. He prepared to work for the
next 48 hours. "We wanted to know what we were dealing with," he said.
The news startled doctors across the country. Center for Disease Control and
Prevention director Dr. Thomas Frieden upstaged his own speech about Zika
virus last week to warn about what the arrival of mcr-1 means for people
everywhere. "The medicine cabinet is empty for some patients. It is the end of
the road for antibiotics unless we act urgently," he said.
Snesrud, however, wasn't shocked. Once bacteria acquire new characteristics,
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Snesrud, however, wasn't shocked. Once bacteria acquire new characteristics,

they generally do get around quickly. The mcr-1 gene had been identified in
food animals and people around the world going back for decades. But never
before in the United States.
"Everything was going so fast. It was 'Oh, my God,'" said Patrick McGann, chief
of molecular research for the MRSN.
"We got it Friday. We were done Monday afternoon."
Snesrud's colleague, Rosslyn Maybank, stayed late that Friday, setting up the
giant PacBio sequencing machine that can read out the entire genome of
microbes and tell researchers not only what genes can be found in an
organism, but where they are.
"We were looking for where the gene was located," said the quiet and
seemingly unflappable Snesrud.
"Was it on the plasmid? Was it in the chromosome?" It was, as expected, on the
plasmid the worst of the two places.
Plasmids are little structures of DNA that exist outside the chromosomes where
most of the DNA is found. They're handy little carriers that can pass off a
stretch of DNA as easily as a courier hands an envelope to a client.
Bacteria can acquire resistance to
antibiotics in several ways. They can
evolve it naturally, through
mutations. Or they can share them
with one another through what's
known as horizontal gene transfer.
They exchange the plasmid through
bacterial sex, often through
Patrick McGann of the Walter Reed Army
Institute of Research shows off one of the superfest gene sequencers that helped his team track
down a superbug with an "ultimate" resistance
gene called mcr-1. Maggie Fox / NBC News
structures called pili. "They create a

little channel and they pass the DNA
through it," McGann said. First,
however, they make a copy for

themselves, so they can also pass that DNA down to their own daughter cells.
Related: Here's Why Doctors Are Worried About the Superbug
Plasmids come in different types, also, said McGann. He likens them to cars. "Is
it a really fast one, like a Ferrari, or is it like a Skoda?" And plasmids don't
respect species distinctions, so bacteria can pass them to different species of
bacteria as if a cat gave some of its genes to a dog, for instance.
It also means doctors don't have to be on the lookout for something as simple
as a methicillin resistant staphylococcus aureas (MRSA) infection. They need to
watch for an already resistant bacteria that's grabbed some genes from, for
example, a type of superbug called carbapenem-resistant enterobacteriaceae
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example, a type of superbug called carbapenem-resistant enterobacteriaceae

or CRE. CRE are the germs that Frieden calls "nightmare bacteria."
In this particular sample, the plasmid was one that can get from one germ to
another very quickly. "It was definitely up there with the Lexus or the BMW,"
said the chatty, Irish-born McGann.
"We are very concerned to see it in there with this particular plasmid." Making
matters worse, the plasmid was carried by E. coli, itself a highly contagious
germ. And this particular E. coli already had superbug characteristics, even
before it picked up the new mcr-1 gene.
It has seven of its own resistance
genes, permanently encoded in the
DNA of its chromosomes. Then it has
seven more on the plasmid.
One piece of good news: the E. coli
wasn't invincible yet. It could be
killed with a class of antibiotics
called carbapenems. The patient, a
49-year-old woman who hasn't been
identified, was treated with
intravenous antibiotics and as now
home and well, said Dr. Mary Hinkle,
an expert in antibiotic resistance
who works on the MRSN team.
Some of the 40,000 samples of bacteria stored
at the Multidrug Resistant Organism Repository
and Surveillance Network (MRSN) lab at the
Walter Reed Army Institute of Research in Silver
Spring, Md. Maggie Fox / NBC News
hopes of finding where and how

she got it.
The big fear is that a CRE will
acquire the mcr-1 gene. A patient
CDC and state health officials are

helping track down everyone the
patient had been in contact with, in
"IT'S VERY IMPORTANT

TO SPOT THESE GUYS
COMING IN EARLY."
infected with such a bug would

have very little hope of treatment.
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From left, Rosslyn Maybank, Ana Ong and Erik Snesrud of the Multidrug Resistant Organism
Repository and Surveillance Network (MRSN) at the Walter Reed Army Institute of Research
worked overtime to identify the first sample for a U.S. patient carrying the mcr-1 antibiotic
resistance gene. Maggie Fox / NBC News
Another piece of good news: The MRSN team has not yet found another
example of the mcr-1 gene in any of the samples they have tested. "We have
tested about another 40 of them so far. There's no sign of it since," McGann
said.
Related: Superbugs Kill 23,000 People a Year
They are painstakingly going through 40,000 samples of bacteria they have
stored in freezers in their labs inside the main blue and yellow building of the
Walter Reed annex in Silver Spring, a suburb of Washington, D.C.
Super-fast sequencers developed in the 15 years since the first human genome
was mapped help a lot. What used to take weeks or months can now be done
in a matter of hours.
A strong work ethic doesn't hurt, either. Snesrud went two days on little or no
sleep; Maybank worked extra hours standing on her feet even though she's
eight months pregnant.
"We pride ourselves on our turnaround time," McGann said.
There aren't many rewards no overtime, no big bonuses for these
government employees. But there are some perks. Snesrud's getting one of
the ultimate honors for a microbiologist a new species named after him. The
team has proposed calling it Pseudomonas snesrudii. It was taken from
someone's skin in Baltimore.
The lab tests samples from around
the world, not only from U.S. military
hospitals but from Israel, France's
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5/31/16 1:51 PM
hospitals but from Israel, France's

Institut Pasteur and elsewhere,
McGann said.
Related: Startling New Superbug
Found in US for the First Time
"They say, 'Hey, we have an E.coli
here. It's weird. Can you guys check
it out?'" said McGann.
The hope is to catch and stop
outbreaks of dangerous new
pathogens fast.
Patrick McGann of the Walter Reed Army
Institute of Research displays a culture of
multiple drug resistant E coli taken from a
Pennsylvania patient. Maggie Fox / NBC
News
"It's very important to spot these

guys coming in early," says McGann.
One outbreak the team thinks they
could have stopped sooner was the spread of a drug-resistant strain of

Acinetobacter baumanii that caused an eight-year-long outbreak among
servicemembers starting in Iraq in 2002.
A baumanii was known for causing horrible wound infections among soldiers in
the Vietnam War. The normally harmless bacteria, found in soil and on skin, got
into the wounds of men and women serving in Iraq and Afghanistan, causing
baffling bloodstream infections.
"If this lab had existed 15 years ago, we would have been able to provide
feedback ... so we could make much smarter choices," Hinkle said.
The team would have been able
to sequence the samples quickly
and tell military doctors which
antibiotic to use, and which
patients to isolate so the bug
didn't spread.
"THEY SAY, 'HEY, WE

HAVE AN E.COLI HERE.
IT'S WEIRD. CAN YOU
GUYS CHECK IT OUT?'"
Instead, doctors were forced to try one antibiotic after another and had no idea
that certain patients were more dangerous than others. Each one failed.
In the end, it was colistin that worked. That's one reason the team's so
concerned to see mcr-1 and its properties that make colistin useless, too.
The CDC, World Health Organization and other groups warn that it's only a
matter of time before people start becoming infected with ultimate superbugs
that cannot be killed by any of the antibiotics in the arsenal.
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5/31/16 1:51 PM
Patrick McGann of the Multidrug Resistant Organism Repository and Surveillance Network
(MRSN) lab at Walter Reed Army Institute of Research points to the screen of a Pacific
Biosciences PacBio sequencer used to help sequence the genome of a sample of E. coli bacteria
that turned out to carry the dreaded mcr-1 resistance gene. Maggie Fox / NBC News
President Barack Obama has directed government agencies to get busy

working on a solution, and the MRSN team at Walter Reed in part of that effort.
Other labs in the large blue complex are working to develop antibiotics that will
bypass all the known resistance mechanisms, and kill even the worst
superbugs.
So are academic centers and a few drug companies, although not as many as
experts would like to see. And drug development takes years.
In the meantime, the MRSN team is acting as one of the first lines of defense,
trying to catch dangerous superbug infections before they can cause
outbreaks.
MAGGIE FOX
TOPICS HEALTH NEWS, MILITARY, SCIENCE NEWS, TECH NEWS

FIRST PUBLISHED MAY 31 2016, 5:06 AM ET
Page 6 of 9
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NEXT STORY Can I Ever Get Pregnant? And Other Questions About Zika Virus
HEALTH ZIKA VIRUS OUTBREAK MAY 31 2016, 12:13 PM ET
Can I Ever Get Pregnant? And Other

Questions About Zika Virus
by MAGGIE FOX
The World Health Organization updated its recommendations Tuesday on

pregnancy, sex and the risk of Zika virus. WHO now agrees with the U.S.
Centers for Disease Control and Prevention, which suggests waiting eight
weeks after any possible exposure to Zika to have unprotected sex.
Zika's steady spread across Latin America and Pacific island nations and its
inevitable arrival in parts of the continental U.S. has many people worried.
Here are some answers to some pressing questions about Zika, sex and
pregnancy:
Can the virus be transmitted by any kind of sex?

So far, the evidence points to male semen as the source of transmission. The
virus is mostly carried around by the Aedes mosquitoes, but there are several
clear examples now of sexual transmission. Almost all of the cases have been
of men infecting women, although there's one documented case of a man
infecting his male sexual partner.
How do doctors know? It becomes clear if one sexual partner has traveled to a
Zika-affected region and the other has not. "We don't know if a woman with
Zika can pass the virus to her sex partners," the CDC advises.
What if I get infected now

and want to get pregnant in
a couple of years? Is my
pregnancy at risk?
There is no evidence backing that
up. The body clears the Zika virus
eventually. There are some viruses
that stay in the body permanently
Pregnant Woman. Media for Medical / UIG
via Getty Images
herpes and the AIDS virus HIV, for

example.
But Zika virus is one that the immune system eventually gets rid of. Several
viruses are known to cause birth defects if the mother is infected during
pregnancy. Rubella, also known as German measles, is an example. But there
was never any evidence that women infected with rubella before they got
pregnant had a higher risk of birth defects in later years.
Page 7 of 9
5/31/16 1:51 PM
pregnant had a higher risk of birth defects in later years.
How long do I have to wait before I get pregnant?

WHO advises that people wait six months to try for a pregnancy if the male
partner had symptoms of Zika, and waiting eight weeks if either partner has
been in an area where Zika virus infection is possible. If a woman is pregnant
and her male partner could possibly have been infected, they should use a
condom or abstain from sex for the whole pregnancy.
"Zika virus can stay in semen longer than in blood, but we don't know exactly
how long Zika stays in semen," the CDC advises. There's a report of one man
who had Zika virus in his semen more than two months after he showed
symptoms of infection. Since half of the pregnancies in the U.S. are unplanned,
CDC also advises using a condom or abstaining from sex for two months if
there's a chance a man has been infected with Zika.
What if I'm pregnant now and get bitten by a mosquito?

Not all mosquitoes carry Zika, even in the places where the virus is actively
spreading. It's the Aedes aegypti and Aedes albopictus mosquitoes that carry
the virus, and one of them has to have bitten someone who's infected and
even then, it takes a couple of days for the virus to build up enough in the
mosquito's body for the insect to transmit the virus to someone else.
So unless you are in an area where Zika is spreading, it's not time to panic.
Women in Zika zones need to take the strongest precautions, however and
that includes using repellents such as DEET, covering up, and staying inside as
much as possible. Women who become infected do need to see a doctor right
away and get regularly tested and then have their pregnancy carefully
monitored. There is no known way to protect a developing fetus from Zika
infection, but doctors do know that not every woman who gets infected during
pregnancy goes on to have a baby with birth defects.
The CDC expects some local outbreaks of Zika in the states where the Aedes
mosquitoes are common, but nothing like the epidemics in Latin American and
Caribbean countries.
If my baby is born normal, are we in the clear?

No one can say yet. The most obvious and horrifying birth defect known to be
caused by Zika infection is microcephaly. The child's head is smaller than
normal because the brain itself is badly damaged. Doctors are now starting to
report subtler birth defects in babies born to women who'd been infected.
They include eye abnormalities, hearing defects and other brain damage.
Some birth defects do not become apparent for years. The CDC is keeping a
registry of all U.S. women who are pregnant and infected with Zika. So far,
they're watching 279 in the 50 states and the territories.
MAGGIE FOX
Page 8 of 9
5/31/16 1:51 PM
TOPICS HEALTH NEWS, KIDS' HEALTH, LATIN AMERICA, LATINO, TRAVEL, U.S. NEWS
FIRST PUBLISHED MAY 31 2016, 12:13 PM ET
NEXT STORY WHO Issues Stricter Safe-Sex Guidelines to Prevent Zika
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Searching for Superbugs: The Lab Looking for the Next Big Threat - NBC News

WATCH LIVE: WHITE HOUSE PRESS BRIEFING

HOME TOP VIDEOS DECISION 2016

ONGOING: ZIKA VIRUS OUTBREAK

HEALTH HEALTH NEWS

DIET & FITNESS

NIGHTLY NEWS TODAY MEET THE PRESS DATELINE

HEALTH MAY 31 2016, 6:34 AM ET

Searching for Superbugs: The Lab

Erik Snesrud of the Walter Reed Army Institute

The sample was loaded into one of

Snesrud, however, wasn't shocked. Once bacteria acquire new characteristics,

structures called pili. "They create a

however, they make a copy for

example, a type of superbug called carbapenem-resistant enterobacteriaceae

hopes of finding where and how

CDC and state health officials are

"IT'S VERY IMPORTANT

infected with such a bug would

hospitals but from Israel, France's

"It's very important to spot these

could have stopped sooner was the spread of a drug-resistant strain of

"THEY SAY, 'HEY, WE

President Barack Obama has directed government agencies to get busy

TOPICS HEALTH NEWS, MILITARY, SCIENCE NEWS, TECH NEWS

HEALTH ZIKA VIRUS OUTBREAK MAY 31 2016, 12:13 PM ET

Can I Ever Get Pregnant? And Other

The World Health Organization updated its recommendations Tuesday on

Can the virus be transmitted by any kind of sex?

What if I get infected now

herpes and the AIDS virus HIV, for

pregnant had a higher risk of birth defects in later years.

How long do I have to wait before I get pregnant?

What if I'm pregnant now and get bitten by a mosquito?

If my baby is born normal, are we in the clear?

PRIVACY POLICY NEW

NBCNEWS.COM SITE MAP

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