Eight Irish hospitals and a community hospital have suffered outbreaks of a lethal superbug, leading to an unspecified number of deaths, according to a confidential HSE report.
Emergency action is needed to contain the outbreaks and avoid more deaths as well as annual costs of at least €40 million, the briefing note on the threat posed by the carbapenemase-producing enterobacteriaceae (CPE) superbug states.
Recent outbreaks in two hospitals and a community hospital have been associated with “a number of deaths”, it says.
CPE, which is resistant to most antibiotics, was first detected in Ireland in 2008 and the first outbreak occurred in University Hospital Limerick in 2014. The bug has been linked to at least 27 deaths in the hospital and was a contributing factor in three of these deaths, The Irish Times reported last year.
The note now says the Limerick outbreak is “ongoing but coming under control”, with “sporadic” new cases.
An outbreak at Tallaght hospital, where 2,000 people have come into contact with CPE, "continues to be managed", almost a year after it emerged.
Other hospitals where CPE outbreaks have occurred are listed in the document as Mayo University Hospital; University Hospital Waterford; St Luke’s Kilkenny; University Hospital Letterkenny; University Hospital Galway; and Navan hospital. An outbreak at Donegal Community Hospital is described as “coming under control” and the original case has died.
Laboratory facilities
In Mayo, a lack of laboratory facilities forced the hospital to outsource patient testing to a private lab, a conference at the Royal College of Physicians of Ireland (RCPI) heard this week. Staff were also critical of a severe lack of isolation rooms and said at one point two patients who tested positive for the bug were readmitted to an open ward.
The number of CPE cases has increased from five in 2012 to 327 last year, according to the briefing note.
Up to 2 per cent of cases involved invasive infections but even colonised carriers (healthy people carrying the bacteria in their bowel) are a significant threat in spreading the bug to vulnerable groups such as the elderly.
“The problem is a potentially massive hidden reservoir that to date has not been quantified due to lack of screening and implementation of guidance.”
CPE can survive in the environment for months, and in a patient’s bowel for years. “In elderly, [it] will likely be for life.” Unlike MRSA, it cannot be removed from the bowel with treatment.
The note prepared for HSE leadership says most of those who currently have the bug in their gut are older patients and those with chronic illnesses who have been inappropriately and excessively prescribed antibiotics. “However, this is likely to spread to the rest of the population and otherwise healthy people are also likely to die if they get an invasive CPE infection (in their bloodstream).”
The note includes quotes from infected patients from the Tallaght and Donegal outbreaks. One refers to “overcrowded wards, I wasn’t surprised I got something”.
“We didn’t know what to do when he came home – could we touch him without gloves,” says a family member. “Felt like a leper, didn’t understand what it meant,” recalls another patient.
Fire-fighting
According to the note, the system will end up paying for CPE “whether we want it or not. The question is how we spend that money – prevention versus fire-fighting outbreaks”.
It estimates the cost of the Limerick outbreak at €4 million since 2015, or up to €5,000 per night for the patients involved. The Tallaght outbreak has cost up to €6 million and forced the postponement of 700 operations.
If these outbreaks are replicated in five other hospitals, the cost would be €20 million a year, the author of the note says, plus another €20 million in litigation costs.
“If action is not taken now this represents an acceptance that CPE will become endemic throughout the healthcare delivery system in Ireland within the next two to five years. Once this is established, the ongoing avoidable deaths and financial costs will be considerable and it is unlikely that containment can be established.”
An emergency escalation of actions to address the threat is proposed. A detailed action plan suggests the creation of a dedicated national response team, limits on antibiotic use, additional staffing and €12 million in extra funding.
CPE are bacteria in the gut that are resistant to most, and sometimes all, antibiotics. The bug is spread from person to person through contact with faecal matter. Where it enters the bloodstream up to half of patients die.
