Superbugs Threatening Hospital Patients in South Africa
A massive threat is emerging in South Africa from a family of super-bugs known as CRE, described as “nightmare bacteria” in the US where cases are increasing.
The superbug belongs to a once-obscure family of drug-resistant bacteria that has stalked hospitals all over the world, and it’s a fight the medical community is finding it hard to win.
The bacteria, known as Carbapenem-Resistant Enterobacteriaceae, or CRE, are named for their ability to fight off carbapenem antibiotics – the last line of defense in the medical toolbox. And so far, they’ve emerged almost exclusively in health care facilities, picking off the weakest of patients.
“The exponential rise of CRE in South Africa has the potential to become a national crisis,” warned clinical microbiologist Dr Adrian Brink, co-chair of the South African Antibiotic Stewardship Programme.
In 2012, 64 patients tested by just one of South Africa’s leading laboratories – Ampath – had CRE, or Carbapenem-Resistant Enterobacteriaceae. A mere 3 years later, this figure has risen to 587 positive patients.
The bacteria’s ability to defeat even the most potent antibiotics has conjured fears of illnesses that can’t be stopped. Death rates among patients with CRE infections can be around 40%, far worse than other, better-known health care infections such as MRSA or C-Diff, which have plagued hospitals and nursing homes for decades.
There are growing concerns that CRE could make its way beyond health facilities and into the general community. The germs live in the gut and can kill up to half the patients who get bloodstream infections.
“The big problem at the moment is CRE,” said Professor Guy Richards, director of critical care at Charlotte Maxeke Johannesburg Academic Hospital.
CRE are among the three most common resistant bacteria found in Mediclinic hospitals, said Briëtte du Toit, manager of infection prevention and control for Mediclinic Southern Africa.
Published on Feb 19, 2015
Jason Newland, MD, Infectious Disease physician, discusses antibiotic resistant superbugs. Seven patients at a California hospital have been infected with a drug-resistant “superbug” and 179 people were exposed to it, according to health officials.
Antibiotic Abuse in SA Breeding ‘Superbugs’
Dr Tom Frieden, director of the Centers for Disease Control and Prevention in the US, said in a report: “CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections.”
Carbapenems are one of the last classes of antibiotics that reliably work against resistant infections.
The menace of superbugs has grown worse since 2004 when the Sunday Times reported that about 1 in 7 patients were at risk of deadly infections in major state and private hospitals in South Africa. Now around 1 in 5 patients admitted to selected state hospitals are at risk of contracting a hospital-acquired infection, often caused by superbugs that are hard to treat.
The statistic was arrived at by a recent survey involving close to 3 000 beds in 13 hospitals across four provinces and conducted under the direction of Professor Adriano Duse, chairman of the South African national working group for the Global Antibiotic Resistance Partnership.
“As this study does not include all state hospitals and did not include private sector hospitals where, in selected facilities infection rates may be as high, if not higher, the results are not generalisable to the South African public or private hospital services,” Duse said.
Gauteng health MEC Qedani Mahlangu said about 1 500 people contracted hospital-acquired infections in Gauteng provincial hospitals from 2012 to 2014. Twenty of these patients died.
Dr Roshini Moodley Naidoo, head of clinical quality management at Discovery Health, said hospitals were not obliged to report healthcare-associated infections.
Immune-compromised patients are the most at risk but any patient can be exposed to superbugs.
Department of Health spokesman Joe Maila said South Africa had developed an antimicrobial strategy and implementation plan in line with the antimicrobial global action plan of the World Health Organisation.
“A strength of the current strategy is the department’s strong working relationship with infectious disease clinicians and microbiologists,” he said. “Antimicrobial resistance has not reached crisis stage yet. However, if the current trend continues, then it is likely that we will have a crisis.”
Mobile Patients = Mobile Bugs
There are many challenges to containing the spread of CRE, but one of the most daunting — and immediate — is figuring out where it’s showing up.
It’s especially important to know where CRE bacteria are emerging because they spread among patients who bounce between or among clinics, surgical centers, rehabilitation facilities, nursing homes and, of course, hospitals.
Not all of those patients are symptomatic: The bacteria can lurk, unseen, until a carrier’s immune system is compromised or until the bug finds a path into the body and infection sets in. And as those patients move from one facility to another, the bacteria move with them, often clinging to caregivers’ hands — and moving to new victims.
Childhood Cancer patients undergo very harsh treatments which seriously impact their immune systems, which is one reason why visitors to the Paediatric Oncology Wards are kept to a minimum. Caregivers or any other visitors could be carriers of the CRE bacteria without realising it and pass the superbug on to one of the childhood cancer patients unknowingly.
These Little Fighters are already faced with such a huge challenge trying to fight off the cancer and the effects of the harsh cancer treatments that they seriously do not need anything else that can threaten their lives.