What YOU need to know about the new superbug

As the Health Minister declares a public health emergency ....

IT’S BEEN known for several years that the prevalence of so-called ‘superbugs’ in Irish hospitals is on the rise. It’s also been known that the single biggest factor in the development of these superbugs is the misuse of antibiotics.

But despite repeated warnings and advice on how and when to take antibiotics, Ireland is now in the grip of a public health emergency thanks to the latest strain of bacteria, which is, so far, proving almost impossible to kill.

Carbapenemase-producing Enterobacteriaceae (CPE) has been found in at least eight healthcare facilities around the country. And last week Health Minister Simon Harris announced he is putting together a National Public Health Emergency Team in response to this potentially lethal new superbug.

‘There is experience from other countries that a vigorous response in good time can contain CPE,’ he said. ‘So I am committed to tackling this with the urgency it requires.’

It would appear that this latest health emergency could be very serious indeed, particularly to vulnerable patients in hospital.

‘Of all the superbugs we have had, CPE is the hardest to kill with antibiotics,’ the HSE has stated. ‘We think the number of people who carry CPE in Ireland is still fairly small. This means that if we take very good care of people who carry it, there is still time to stop it becoming very common.’

The Centre for Disease Control estimates that every year about two million people worldwide get sick from a superbug and about 23,000 die.

PROBABLY the bestknown superbug is Methicillin-resistant Staphylococcus Aureus (MRSA). It’s a strain of staphylococcus infection that’s difficult to treat, but although it’s considered antibiotic-resistant, there are still some antibiotics it responds to and the frequency of life-threatening cases of MRSA has declined in recent times.

CPE, however, would seem to be a different kettle of fish, one that is now posing a very serious risk to patients in Irish hospitals.

According to the CDC, patients whose care requires devices such as ventilators and catheters and those who are taking long courses of certain antibiotics are most at risk from CPE infections.

It’s a bacteria that is found in the gut and if it stays there, it’s mostly harmless. But if it spreads to the urine or blood it can be fatal. Indeed it’s estimated that more than half of all patients who develop blood stream infections with CPE will die.

The first case in Ireland was detected in 2009. Last week the HSE revealed that so far in 2017, up to the end of September, 306 people have been confirmed as having CPE. This compares to 283 last year.

‘These numbers include new patients testing positive for CPE in Ireland,’ the HSE said. ‘Most of these patients are carrying CPE but are not sick as a result. But a number of patients have had serious infection.’

The HSE added that it was ‘extremely difficult to put exact numbers on mortality rates because many of the people who die early as a result of antibiotic resistance are people who already had an underlying serious illness.’

However they also said: ‘Clinical antibiotic resistance is making people suffer more and die younger than they need to.’

Information from the HSE on CPE, which is also referred to as Carbapenem-resistant Enterobacteriaceae (CRE), explains how, for most patients, the bacteria live harmlessly in the bowel and do not cause infection, which is known as ‘colonisation’.

‘This is because the person’s immune system keeps CRE in check in the bowel and prevents it from spreading elsewhere in the body,’ the HSE said.

‘Sometimes, however, CRE can cause infection in patients. For example, when they need intensive care or while receiving chemotherapy. CRE can cause infections, such as kidney infections, wound infections or in severe cases, blood infection.’

CRE is carried in faeces and spreads when tiny fragments are swallowed by a non-infected person. ‘It can spread between patients through direct contact with each other or by touching items or surfaces that the person with CRE may have touched such as bed rails, toilets or equipment.’ explained the HSE.

‘As patients in hospital are much more vulnerable to infection than patients in their own homes, special precautions are required to prevent the spread of CRE between patients in hospital.’

A simple swab test, taken from a patient’s back passage, is used to check whether they have CPE. It usually takes a couple of weeks for the results to come back.

According to HSE guidelines, if a patient tests positive for the bacteria, the hospital will try to make sure the infected person has their own room, toilet and shower to prevent any further spread.

‘You [the patient] will stay in an isolation room until the final results are received,’ the guidelines state. ‘If CRE is picked up in the sample, you will stay in the isolation room for the duration of your hospital stay, to prevent spreading CRE to other patients.’

Staff dealing with you will also wear extra protective clothing such as aprons, gloves and surgical gowns.

HSE Director General Tony O’Brien, has written to the Health Minister to warn him that the rise of this superbug, and the costs associated with trying to contain it, will put extra pressure on an already stressed health service.

He is seeking nearly €8 million in additional funding to allow the HSE to recruit up to 80 staff, including microbiologists and laboratory workers, to deal with the threat.

He wrote: ‘If we do not effectively balance actions to pre-empt winter pressures and actions to control the spread of healthcareassociated infections, we will continue to have avoidable deaths, we will continue to have outbreaks in our acute hospitals, which will result in closures of hospitals to elective admissions.’

O’Brien also revealed that a new strain of CPE has proved impossible to treat with current medication. ‘The challenge has escalated to a new level with the first detection in a hospital in Ireland in June 2017 of a CPE that also carries a gene called MCR,’ he explained.

‘The CPE bacteria are also resistant to colistin, which has become one of the few antibiotics that we have been able to rely on for the treatment of CPE.’

EXPERTS in this field have long warned that the misuse of antibiotics is the biggest cause of new superbugs and they have expressed their fears that medics will eventually run out of drugs to treat them.

‘The public should know that the more antibiotics you’ve taken, the higher your superbug risk,’ explained US doctor Eric Biondi, who runs a programme to decrease unnecessary antibiotic use. ‘And the more encounters you have with the hospital setting, the higher your superbug risk.’

As more bacteria become resistant to more commonly used antibiotics, doctors will have to resort to newer drugs, which can be more expensive and can be associated with severe side-effects.

Medics campaigning for safer use of antibiotics have several pieces of advice for the public.

First, you need to understand when antibiotics should be used. They are only effective against bacterial infections and should never be used for viral infections such as a cold or flu.

It is also important to follow your doctor’s instructions precisely when you are prescribed an antibiotic. If you stop taking your medication early it can lead to the bacteria surviving and spreading.

Antibiotics should never be taken without a prescription. Leftover antibiotics might not be the appropriate choice for your condition or may not be enough to combat the infection.

Finally, good hygiene prevents the spread of infection, so wash your hands before eating and after going to the bathroom or visiting a hospital.