Workers and mattress shortages compound the ‘superbug’ menace to sufferers in hospital – The Irish Occasions

As measures to contain the spread of Covid-19 were lifted across the country, the prevalence of superbugs in Ireland’s hospital system rose again. Some are at higher levels than before the pandemic.

According to Hilary Humphreys, Professor Emeritus of Clinical Microbiology at the Royal College of Surgeons in Ireland (RCSI), the “overshooting” is not surprising due to renewed pressure on the healthcare system.

Analysis of official figures from The Irish Times shows that there were 338 cases of hospital-acquired Staphylococcus aureus bloodstream infections in 2019. That number dropped to 287 in 2020 when the Covid-19 pandemic hit Ireland. However, it rose again last year, reaching 352.

Not all of these infections are the superbug MRSA, most are MSSA which are easier to treat. However, its presence is still of concern because of the associated mortality even without the antibiotic-resistant component.

The occurrence of carbapenemase-producing Enterobacterales (CPE) is also higher today than it was three years ago. In 2019, 661 patients with the resistant pathogen were detected. It fell to 656 in 2020 but rose to 682 in 2021.

Prof Humphreys said that increase between 2020 and last year was due to several worsening situations within the hospital system.

According to Prof. Hilary Humphreys, bed shortages mean that extra beds are placed in places where there isn’t enough space, which contributes to the spread of insects. Photo: Cyril Byrne

“More and more people are coming to the hospital; because of delays [during the pandemic] You couldn’t participate before. We’re back to normal now,” he said.

“As we speak, the system is under a lot of pressure, staff shortages and the like. Bed shortages obviously have all sorts of knock-on effects, including patients presenting later with a more complex risk of infection than if they presented earlier in their illness. Bed shortages also mean that we put extra beds where there is not enough space.”

The most worrying superbug for healthcare is CPE.

10 to 20 years ago MRSA would have been the biggest problem. However, according to the Health Protection Surveillance Center (HPSC), the prevalence of the virus reached its lowest level ever in the past year, accounting for just over 10 percent of cases of S aureus bloodstream infections.

Although the threat MRSA has not gone away, CPE has overtaken it in numbers, according to Dr. Eimear Brannigan, HSE Clinical Lead for Antimicrobial Resistance and Infection Control.

It is generally considered the most dangerous superbug because it is resistant to almost all antibiotics. In 2017, a National Public Health Emergency Response Team was established to combat CPE.

It unofficially resigned a few years ago after holding its last meeting in 2019, just before the Covid-19 threat became a priority. However, after the effects of the Sars virus have largely subsided, CPE is rising again.

The HPSC says the five-year trend for CPE is increasing in Ireland, with 113 cases reported in October 2022 alone, the highest detection rate in one month since surveillance began in 2019.

It emerged that in September there were 11 hospital outbreaks across the state: at Tallaght University Hospital; MRH Mullingar; St Luke’s Hospital, Kilkenny; University Hospital St Vincent; Beaumont Hospital; University Hospital Galway; University Hospital Sligo; University Hospital Cork; Mercy University Hospital, Cork; University Hospital Waterford; and University Hospital Limerick.

An unpublished 2019 HSE document obtained by The Irish Times under freedom of information laws found that there were “persistent environmental reservoirs” of superbug CPE in several hospitals, likely a “significant contributor” to the number of the patients who became infected with the virus.

The reservoirs are sinks, drains and other structural bodies of water that can become infected with the organism, although the HSE has undertaken some capital work to reduce numbers.

However, not all superbugs rise. VRE in Ireland has a higher prevalence rate than other European countries, but this difference has narrowed over time.

dr Susie Frost, consulting microbiologist at the HPSC, said it has not been fully understood why Ireland typically has a higher level of prevalence, although there are suspicions it may be related to agriculture.

The HPSC only measures VRE bloodstream infections, but the number of Irish patients who are colonized with the organism, ie those who carry the bacterium but are not sick, is significantly higher.

For example, according to figures obtained under freedom of information laws by The Irish Times, Cork University Hospital had 699 VRE detections in 2019. The HPSC numbers for the hospital that year were 12.

C Diff also remains lower than before the pandemic, with 717 hospital-acquired cases last year, compared with 1,005 in 2019.

The prevalence of superbugs, as they are often called, is of concern as it can delay recovery or cause death.

And while there are implications for the individual patient, there are implications for the healthcare system as well.

A 2010 American study published in the International Journal of Pharmaceutical and Healthcare Marketing states that a day in the hospital increases the risk of contracting a health-related infection (HAI) by 1.37 percent, with each HAI increasing an additional duration of 9.3 days.

According to a report by the Health Information and Quality Authority (Hiqa), antimicrobial resistance to eight bacteria of public health importance cost the healthcare system an additional €12 million in extra hospital bed-days in 2019.

Hiqa also found that these resistant infections resulted in about 215 deaths and almost 5,000 years of complete health.

dr Máirín Ryan, Head of Health Technology Assessment at Hiqa

dr Máirín Ryan, Executive Vice President and Director of Health Technology Assessment at Hiqa, said: “To put this in context, this is similar to the burden being reported in Ireland for certain cancers and rheumatoid arthritis.”

dr Brannigan added that while those numbers are “significant,” they are “likely an underestimate,” a position supported by Hiqa.

A recent study published in the Lancet confirmed this assumption, finding that drug-resistant superbugs were responsible for more than 370 deaths in Irish patients in 2019.

Last month, Andrea Ammon, director of the European Center for Disease Prevention and Control (ECDC), said there were “worrying increases in the number of deaths from infections with antimicrobial-resistant bacteria, particularly those that are last-line resistant , see antimicrobial treatment”.

However, preventing these bugs from spreading is not easy. In 2019, then-HSE Director-General Paul Reid said antibiotic-resistant superbugs posed an “existential threat” to public health that could become an irreversible problem.

Overcrowding and staff shortages are two of the main reasons they continue to have a presence in our health service.

dr Brannigan said, “If they [patients] If you can stretch out and touch the nearest bed or trolley, then that is clearly a hazard to other people. You can see why crowding isn’t good.”

Prof Humphreys agreed, stating that if they had insufficient staff numbers, they would be under more pressure, which meant “they may not be following hand hygiene as they normally would”.

So it’s clear that until there are enough beds and staff, the superbug threat to the Irish healthcare system isn’t really going to diminish.

The bugs

Clostridium Difficile: Often referred to as C Diff, the organism thrives when the normal, healthy gut bacteria are disrupted. For someone suffering from C Diff, it often means diarrhea that usually only lasts a few days before calming down. However, it can be serious, especially in frail, elderly people who tend to have bloated bellies and sometimes need surgery to remove part of their colon.

MRSA: Many people have a common type of bacteria in their nose called Staphylococcus aureus (SA), which can cause mild skin infections. Methicillin is a group of antibiotics used to treat SA infections, and the term MRSA refers to a type of SA that does not respond to treatment with antibiotics such as methicillin. If MRSA, or even MSSA, which can be treated with methicillin, enters the bloodstream, it can be fatal to vulnerable patients.

CPE: Carbapenemase-producing Enterobacteria, more commonly referred to as CPE, are bacteria that live in the gut. A superbug of sorts, they are resistant to many antibiotics, meaning there are often limited treatment options for those who develop them. It is currently the most worrying superbug for HSE as it is resistant to almost all antibiotics.

Vancomycin-Resistant Enterococci (VRE): Enterococci are bacteria found in the feces of most humans and many animals. The most common are urinary tract and wound infections. It often occurs in patients who have been hospitalized for a long time, in patients taking certain antibiotics, and in patients who are fed by feeding tubes.

ESBL: Extended-spectrum beta-lactamesis, or ESBLs, are common antibiotic-resistant bacteria that can cause serious infection if they get into the blood, kidneys, bladder, or body tissues. There are three things that increase the risk of ESBL infection: major surgery, inserting a medical device into your body, such as a a catheter or IV line, and cancer treatment.

SRSV: The small, roundish virus, often called winter vomit, is a particularly resilient microorganism that spreads through the air and through personal contact. Symptoms include severe, often projectile, vomiting, diarrhea, abdominal pain, and low-grade fever. However, most disappear within 48 to 72 hours, and many are able to recover without hospital care.