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South Africa is staring down the barrel of a microbial health apocalypse. A family of antibiotic-defying bugs called CRE is gaining ground, which is no garden-variety germ.
These things have earned the nickname “nightmare bacteria” from the US Centres for Disease Control, and for good reason, as they shrug off our best antibiotics like it’s nothing.
“The exponential rise of Carbapenem-Resistant Enterobacteriaceae (CRE) in South Africa has the potential to become a national crisis,” warned clinical microbiologist Dr Adrian Brink, co-chair of the South African Antibiotic Stewardship Programme, per TimesLIVE.
It’s escalating fast, and if we don’t slam the brakes hard and soon, we’re in for a world of hurt.
Back in 2012, only 64 people tested positive for CRE through Ampath, one of the big diagnostic labs. Fast-forward three years, and that number had ballooned to 587. Forget red flags, that’s a five-alarm fire.
These microscopic thugs camp out in your gut, but don’t let their choice of real estate fool you, as they’re killers. Up to half the people who get bloodstream infections from them don’t make it out alive.
“The big problem at the moment is CRE,” said Professor Guy Richards, director of critical care at Charlotte Maxeke Johannesburg Academic Hospital. You know it’s serious when a guy running an ICU calls it the big problem.
MRSA, the methicillin-resistant Staphylococcus aureus, “was the big bug that the public was aware of 10 years ago,” the professor said. Now it’s CRE hogging the spotlight, and not in a good way.
CRE is one of the top three drug-resistant bugs creeping through Mediclinic hospitals, according to Briëtte du Toit, who heads up infection prevention for Mediclinic Southern Africa. So yeah, this isn’t just an isolated outbreak in some rural hospital, it’s everywhere.
Over in the States, CDC boss Dr Tom Frieden said,”CRE are nightmare bacteria. Our strongest antibiotics don’t work and patients are left with potentially untreatable infections.”
When the guy running America’s disease control agency calls it a nightmare, we ought to lose some sleep.
Carbapenems, those big-gun antibiotics reserved for the worst infections, used to be the cavalry. Now, CRE just flips them the bird. This isn’t even a new problem. The Sunday Times was already ringing alarm bells back in 2004, reporting that one in seven patients in major hospitals were at risk of catching something deadly.
Since then, things haven’t improved much. A more recent survey across 13 hospitals found that roughly one in five patients are now at risk of getting hit with a hospital-acquired infection, many of them courtesy of drug-resistant nasties like CRE.
In Gauteng alone, about 1,500 people caught hospital-acquired infections between 2012 and 2014, according to health MEC Qedani Mahlangu. And 20 of them didn’t make it. That’s 20 lives cut short by bugs that should’ve never gotten the upper hand.
Dr Roshini Moodley Naidoo, head of clinical quality management at Discovery Health, points out a major hole in the system: nobody’s actually forcing hospitals to report these infections.
“Infections are in general significantly under-reported,” she said. “We have anecdotal and other evidence [such as the use of certain antibiotics] of infection outbreaks in some hospitals.”
Private hospital giants Mediclinic and Netcare say their infection rates are within the international norm, but when the “norm” includes rising antibiotic resistance, that’s not exactly reassuring. It’s not just ICU patients who need to worry. Even people heading in for routine surgeries like knee replacements are increasingly walking out with more than just a scar.
“It is quite common for patients to go in for a procedure like a knee or hip replacement and develop an infection,” Richards said.
Surgical site infections, catheter-related bloodstream infections, ventilator-associated pneumonia, urinary tract infections – these are the greatest hits of hospital bugs. And CRE wants the top spot on the charts.
But it’s not all doom in Petri dishes.
Some hospitals – academic, public and private – are fighting back with surveillance systems, early detection, and strict infection control protocols. It’s a game of chess with bacteria, and they’re trying to stay one move ahead.
Medical aids like Discovery, Bonitas and GEMS are also starting to rate hospitals on infection, death and readmission rates. So at least someone’s watching. Many hospitals have also jumped on board the “Best Care Always” campaign, started in 2009 to tackle hospital infections and encourage better antibiotic use.
“Hundreds of lives have been saved and much harm averted,” Naidoo said, citing estimates from campaign data.
There’s also a national plan in play. Department of Health spokesman Joe Maila said South Africa had developed an antimicrobial strategy and implementation plan in line with the antimicrobial global action plan of the World Health Organisation.
“A strength of the current strategy is the department’s strong working relationship with infectious disease clinicians and microbiologists,” he said.
“Antimicrobial resistance has not reached crisis stage yet. However, if the current trend continues, then it is likely that we will have a crisis.”
So basically, stay tuned, because this could turn into a full-blown microbial meltdown if we don’t act fast and decisively.
[Source: TimesLIVE]
