New organisms worsen challenge of antibiotic resistance

Antibiotic resistance is one of the greatest challenges facing health services around the world, numerous reports have told us over the past year.

Currently, 700,000 people a year die because their conditions are resistant to the antibiotics traditionally administered to tackle them, and this figure will rise to 10 million within decades unless a solution is found.

In Ireland, progress has been made in reducing the level of infections caused by organisms that were a significant concern a decade ago. Superbugs such as MRSA haven’t gone away, but the number of patients infected during hospital stays has declined steadily.

However, the ground on which the battle against antibiotic resistance is fought constantly changes, and so new organisms have emerged to create problems in the overcrowded, overstretched Irish health system.

Worryingly, the threat they pose is ever greater, because many of them are resistant to all but the most potent antibiotics and they are difficult, if not impossible, to eradicate.

Of particular concern is the emergence of what is termed carbapenemase-producing Enterobacteriaceae (CPE), which results in some cases of bacteria being resistant to all conventionally-used antibiotics. The carbapenemases are enzymes that work by inactivating antibiotics.

University Hospital Limerick

The latest figures from the HSE’s Health Protection Surveillance Centre shows the number of CPE cases rose from 48 in 2013 to 81 in 2014 and 140 last year. There were 132 cases in the first eight months of this year – and that was before a major outbreak began in Tallaght Hospital in August.

The driver behind this upward trend has been a persistent outbreak in Limerick, mostly affecting University Hospital Limerick but with cases reported also in other hospitals and nursing homes locally.

Limerick was the first area in Ireland to report different versions of the CPE problem, including KPC and the virulent NDM enzyme, first named after Swedish patients who came back from dental work in New Delhi with more than they bargained for.

Some of the Limerick patients had returned from travel abroad but, worryingly, most cases appear to have originated within the hospital.

Staff locally and experts nationally fear CPE is endemic in Limerick and may prove impossible to eradicate. Studies suggest the bug kills about 40 per cent of people who become infected, especially older, frail patients with multiple medical problems and compromised immune systems.

The costs for the health service, if superbugs continue to make inroads, are enormous. Best practice suggests affected patients need to be treated by dedicated staff in single rooms, isolated from other patients, and equipment cannot be re-used.

For patients, the bacteria don’t usually pose a risk for healthy people but can be spread person to person through contact with infected people, particularly contact with wounds or stools. They can cause infections when they enter the body, often through medical devices such as ventilators, catheters, or wounds caused by injury or surgery.

The result can be serious illness, longer hospital stays and, in some cases, death.

Staff have repeatedly flagged the problems in the Limerick hospital with infection control, but still new cases are detected.

In a report published last year, the Health Information and Quality Authority expressed concern that the HSE had failed to proactively identify the CPE risk in Limerick, or to mobilise against it. It said the hospital has insufficient isolation facilities and poor infrastructure in other areas.

Earlier this month, the hospital recorded a national record of 66 patients waiting for admission on a single day. The planned opening of a new emergency department, expected early in the New Year, is unlikely to solve the hospital’s continuing problems with superbugs.