A Superbug Outbreak at NIH

Patient zero

A 43-year-old woman with complications from a lung transplant is transferred from a New York City hospital with a highly resistant superbug known as KPC. The NIH is one of the most prestigious research hospitals in the country, but it has never had a case of KPC before. “We immediately went on high alert, the equivalent of hospital epidemiology Def-con 5,” David Henderson, the clinical center’s deputy director later told FRONTLINE. “And we tried to implement as many things as we could think of at the time to prevent any further spread of the organism in the hospital.” The patient was later discharged, and hospital officials believed they’d contained the bug.

A second infection

Several weeks later, a 34-year-old man hospitalized with a tumor tests positive for KPC. The two patients have no known link: They spent no time in the ICU together, and they had different caregivers and equipment.

Outbreak

Over the next few months, several more patients test positive for KPC. As the NIH attempts to deal with the outbreak, no combination of antibiotics seems to be able to stop it.

Beyond the ICU

The hospital creates a separate ICU for KPC patients. The old ICU is cleaned out and disinfected by robots before patients are moved back in. But somehow, it spreads beyond the ICU.

The victims

Doctors try several combinations of antibiotics — even an experimental drug still in development. Nothing works. And some patients die.

Underlying conditions

Five other patients die, but the hospital believes their deaths are due to their underlying health problems, not the KPC infection. Ultimately, 11 infected patients die.

Looking for a link

Finally, the outbreak seems to have been contained. Throughout the outbreak, the hospital used genetic analysis to help understand the transmission sequence. They compared samples from each patient, along with information such as whether patients overlapped in the same ward, to track the most plausible transmission sequence:

• Black lines mean the infected patient was in the same ward, which likely provided an opportunity for the KPC to spread to the next patient.
• Brown lines indicate the two patients had no overlap, but genetic analysis makes clear the bacteria in the two patients were closely related and likely spread in a more complicated path.
• Dotted black lines mean the patients shared a ward, but there’s at least one other way they might have been infected.
• Dotted brown lines mean the patients didn’t overlap in a ward, but there’s more than one way they might have been infected.

One more patient

Then, a year after the outbreak, a young man arrives at NIH due to complications from a bone marrow transplant. He becomes infected with KPC and dies.

Today, the NIH knows that KPC isn’t gone from the hospital. “Oh no, absolutely not,” Tara Palmore, an infectious disease specialist at the NIH, told FRONTLINE. “I think that we have to be extremely vigilant in the coming years, because of the increasing rise, the increasing prevalence of KPCs in the United States.”