What is a superbug exactly? How do they spread? What makes them so deadly, and what can be done to protect health employees and their patients? Gareth Greathead reports.
In 2012, a superbug by the name of carbapenem-resistant enterobacteriaceae (CRE), also known as the “nightmare bacteria”, found its way from the United States of America to South Africa.
This event brought superbugs into the headlines as seemingly healthy people were booked into hospital for routine procedures and spent weeks there before being released, if they were that lucky.
Since then the proliferation of several types of superbugs has caused healthcare professionals to ask what can be done to prevent their spread.
What is a superbug?
“Superbug” is a general term used to describe multi-drug-resistant bacteria (MDR).
The truth is superbugs are nothing new, but more people are being infected and the infections are getting harder to treat.
MDR bacteria currently cause an estimated 700 000 deaths worldwide. The World Bank estimates that a growing number of antibiotic-resistant bacteria and other resistant germs may cause ten-million deaths a year by 2050.
Some of the common ones are CRE, methicillin-resistant staphylococcus aureus (MRSA), carbapenem-resistant klebsiella, multi-drug-resistant tuberculosis, pseudomonas aeruginosa, acinetobacter baumannii and antibiotic-resistant gonorrhea.
People with weak immune systems are most at risk when it comes contracting superbugs. This includes newborn babies, the elderly, the sickly, burn victims as well as patients who spend an extended amount of time at care facilities.
What causes superbugs to spread?
Marc Mendelson, professor of Infectious Diseases and head of the Division of Infectious Diseases and HIV Medicine at the University of Cape Town and Groote Schuur Hospital, says: “In South Africa, antibiotic resistance is being driven by the incorrect use of antibiotics.”
He goes on to explain that some ill-informed doctors have been using antibiotics to treat viral infections like the common cold. On the other hand, in an attempt to speed up recovery, some patients request antibiotics from their doctors without knowing the ramifications.
Either way, the use of antibiotics is likely to do harm because it kills off the good bacteria as well as the bad, weakening a person’s immune system.
A problem is also created when people are prescribed a course of antibiotics and stop taking them once they start to feel better. In this instance, the good bacteria and those less resilient to antibiotics are killed off leaving the worst to thrive.
As a member state of the World Health Organisation, South Africa has an antibiotic-resistance strategy in place that was published in May 2014. It aims to limit the use antibiotics for treatment of infections that have proved resilient to alternative forms of treatment.
How to prevent the spread
Mendelson says: “Infection control is critical to reduce transmission of the bug.”
Guy Richards, professor and academic head of Critical Care at Wits University, elaborates: “Good infection control means washing hands between patients‚ ensuring stethoscopes and pens are washed between patients‚ and making sure doctors wear disposable aprons.”
In a surgical setting, preventing the spread of dangerous microorganisms from one patient to another relies on proper sterilisation of surgical instruments and other medical supplies.
Superbug-causing bacteria can dwell in hospitals. As such, disinfecting surfaces and general cleanliness remain an important aspect of control. To supplement its existing disinfection routine, Netcare has been experimenting with a specialised fleet of robots in its hospitals.
The robots, made by Xenex, use pulsed high-intensity xenon ultraviolet light to destroy viruses, bacteria and fungal spores.
Superbugs in 2018
Klebsiella is a common bacterium that lives in the gut, often without causing any issues. A problem is created when it gets into other areas of a person’s body where the bacteria become difficult to treat with regular antibiotics.
As an infectious disease it is spread through contact, especially improperly sanitised ventilation tubes. It can give a patient pneumonia, infect wounds or blood and cause other serious problems.
Between July and September this year, 11 babies caught klebsiella pneumonia and six died at the Thelle Mogoerane Regional Hospital in the East Rand.
Jack Bloom, Democratic Alliance MEC on Health in the Gauteng Provincial Legislature, has blamed poor hospital management, overcrowding and understaffing for what he calls, “filthy conditions in the baby ward of death”.
When commenting on the situation, Richards did not dispute that infection-control procedures were probably inadequate. At the same time he said that there would not be a hospital in South Africa that didn’t have the increasingly common antibiotic-resistant klebsiella bacteria.
“The problem is not just with klebsiella‚ but a group of organisms that fall into the same class. There are a growing number of bacteria that are resistant to antibiotics – it’s a global emergency,” says Richards.
If it can be proved that a hospital is negligent in its efforts to contain the spread of superbugs this could result in claims for compensation.
When responding to the latest klebsiella outbreak, the South African Human Rights Commission spokesman, Buang Jones, said the commission was in contact with the families who had lost babies in an attempt to aid them in launching a civil claim against the department.
“We have offered to mediate between families and the department to reach a settlement and prevent a drawn-out court battle,” said Jones. Should mediation be refused by the Gauteng Health Department‚ the commission has expressed its willingness to offer the mothers legal assistance in court.
The Gauteng Health Department has more than R21 billion in medical negligence suits against it‚ according to a Gauteng legislature reply by MEC of Health, Gwen Ramokgopa, earlier this year. “A lot of the claims are related to injuries that babies and mothers suffer during labour,” said Ramokgopa.
Superbugs are nothing new, but present a new threat within a society where our reliance on medication has made us more susceptible to illness. As superbugs are difficult to treat and seem to be impossible to eradicate, for now the only hope lies in awareness and effective infection control.