Research lecture - Beyond Superbugs

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Mer is the Principal Specialist in the Division of Critical Care and Pulmonology, Department of Medicine, Faculty of Health Sciences at Wits University and Lipman, is a past Wits Medical School graduate who currently lives in Australia. He is the Head of Anaesthesiology and Critical Care at the University of Queensland School of Medicine and Director of the Department of Intensive Care Medicine at the Royal Brisbane and Women's Hospital.

"The single biggest killer of people with HIV is TB because TB bacteria love attacking people with suppressed immune systems," says Mer, who has a major interest in treating infections in critically ill patients, including those with HIV/AIDS and TB.

"One person dies from TB every 20 seconds globally and one in 100 South Africans has TB. There are now questions as to whether we are treating TB correctly in critically ill patients.

"Emerging data suggests that the level of anti-TB drugs being given may not be adequate in these patients. Based on this, we are about to embark on a major research project, drawing on the pioneering research and technology which Professor Lipman has developed."

Four decades of research

It has taken Professor Lipman four decades and work on three continents to redefine the use of, and particularly the dosing of antibiotics in critically ill, ICU patients with bacterial infections.

"In ICUs worldwide, doctors are extremely concerned that deadly bacteria known as 'superbugs' are rapidly spreading and developing resistance to all antibiotics. To beat the superbug we have to rectify a common and deadly practice in hospitals, of under-dosing antibiotics in ICUs," Prof Lipman explains.

"For infections, the solution for patients in ICU is a high dose initially to kill off as many causative bacterial bugs as soon as possible. The dose can be reduced from here. Equally important is optimum ward and hand hygiene as bacterial bugs and superbugs are highly infectious and spread easily, including through healthcare workers' hands."

"This is the only way to beat bacterial infections and also to prolong the lifespan and efficacy of antibiotics," adds Mer. "Superbugs have become resistant to so many contemporary antibiotics that we have had to reintroduce some antibiotics that first became available 40 to 50 years ago."

"If we make proper use of the antibiotics that are still effective, we can prolong their life; if we do not, we are in huge trouble because the pharmaceutical companies are not producing new generations of antibiotics." He has been advocating the need for enhanced approaches to infection control and monitoring in state and private hospital ICUs for many years.

The ICU patient is a very distinctive type of patient; when severely infected they often swell up. This is attributed to a number of factors, including the resuscitation process and trauma-related organ damage.

"With swelling there is extra water in the body and we have to ensure there is an adequate concentration of the antibiotic in the blood to reach all the cells as soon as possible," continues Lipman.

"If we do not do this, bacteria, which are extremely clever organisms that constantly swap genetic material amongst themselves, become increasingly robust and resistant to antibiotics."

Lipman runs the best ICU in the world for antibiotic administration, says Mer. They monitor the use of every single antibiotic, ensuring adequate concentrations in every ICU patient in order to treat their infections optimally.

"We do not have this in South Africa and we urgently require the technology and training in this country, with which Prof Lipman can assist us, and it would not be too costly.

"Based on this, we can also look at the TB drugs we use and whether, as with antibiotics, we should be giving higher doses to critically ill patients. If we can demonstrate that we are not achieving adequate levels then we have to change. This may save hundreds of thousands of lives," concludes Mer.