Superbugs may invade SA hospitals

One private laboratory, Ampath, has detected 96 CRE cases since February 2011.

The bug has been found in private and public hospitals around the country. Able to survive in the human stomach and on hospital surfaces, it turns treatable infections into life-threatening illnesses by transferring its own drug resistance to the host. It can be passed from patient to patient in hospitals.

The bug has yet to be declared a notifiable disease and hospitals do not have to report cases, so the full extent of the problem is not known.

CREs are just one of several new multi-drug-resistant superbugs that have developed mostly because of the incorrect use of antibiotics.

Now the institute wants the government to declare CREs a notifiable disease, which will force hospitals to report every case.

"This number [63] does not represent the national prevalence of CREs, but it is a warning of emerging resistance that threatens to produce an epidemic of CREs," the state laboratory said in its latest communicable diseases communique.

The institute's principal pathologist, Olga Perovic, said: "There is a problem. We need to face it. That is what we are trying to do."

The government is finalising a report into a recent CRE outbreak on the East Rand of a bug called NDM-1. Other superbugs reported in the country include OXA, KPC, VIM and GES.

Global problem

Drug-resistant bugs are a global problem. The UK's most senior medical adviser has called for them to be classified on the national risk register for civil emergencies on a par with terrorist attacks.

Adrian Brink, head of microbiology at Ampath, said: "It is an emerging threat; there is no doubt about it. What we are seeing is a spread of drug-resistant bugs throughout the country."

Private healthcare group Life Healthcare declined to divulge how many cases had been found in its hospitals. Spokesman Julie MacLiam said hospital screening had detected "one or two new cases every month" on the East Rand so far this year.

"We take a proactive ultra-cautious approach to all positive results and isolate those patients until discharge," MacLiam said.

Figures published by the South African Society for Clinical Microbiology show that drug-resistant bugs are spreading.

The figures, which do not specify CRE superbug infections, are based on tests of serious infections by several laboratories. They found:

• More than 400 cases of P.aeruginosa bacteria from January to June 2012. The bug attacks damaged tissue and infects patients with low immunity; 12% of 44 cases in Cape Town were resistant last-resort antibiotics;
• Only two of more than 800 cases of Klebsiella pneumonia responded to Ampicillin, the most common antibiotic. In Johannesburg, more than 60% of these cases were resistant to all but one class of antibiotic;

• In Durban, 27% of 217 cases of E.coli were resistant to most antibiotics.

Professor Mark Nicol, chairman of the South African Society for Clinical Microbiology, said the country lacked the surveillance needed to get an accurate picture of superbug infections.

He said many multi-drug-resistant bacteria were now endemic to South African hospitals and if the same thing happened with totally-drug-resistant superbugs, the healthcare system would face a potential crisis.

"It is very difficult to eradicate these drug-resistant organisms once they have a foothold, because their primary reservoir is in people's guts," Nicol said.

Guy Richards, head of the intensive care unit at Charlotte Maxeke Johannesburg Academic Hospital, said drug-resistant bugs often arrived with foreign visitors. "Major sources are Angola and Nigeria, where minimal antimicrobial monitoring is done," he said.

Source: Sunday Times via I-Net Bridge