Half of patients treated in intensive care units around the globe have infections and more than two out of three are treated with antibiotics, according to a new study. The findings raise concerns about the effectiveness of efforts to reduce hospital-acquired infections worldwide.
The study included data from nearly 14,000 adult patients treated at nearly 1,300 ICUs in 75 countries. Just as they had done twelve years earlier, researchers recorded the prevalence of infections and antibiotic treatment among the ICU patients during a single day in 2007.
Fifty-one (51%) percent of ICU patients had infections and 71% were being treated with antibiotics, compared to 45% and 62%, respectively, in the 1995 analysis.
The new research appears in this week's edition of The Journal of the American Medical Association.
• Infected patients were more than twice as likely to die while still being treated in the ICU than non-infected patients (25% vs. 11%).
• Respiratory infections were most common, accounting for 64% of all infections reported. Other infection sites included the abdomen (20%), the bloodstream (15%), and urinary tract (14%).
• Infection rates were higher among patients with longer ICU stays: 32% of patients hospitalized in the ICU for no more than one day were infected compared to 70% of patients treated in ICUs for more than a week.
Central and South America had the highest overall infection rates (60%) of the countries included in the study, while Africa had the lowest (46%). The single-day infection rates in North America and Western Europe were 48% and 49%, respectively.
Twenty-seven percent of cultures from North American were positive for S. aureus and two-thirds of these were methicillin resistant. In an editorial published with the study, Opal warns that the infection-related death rate among hospitalized patients will continue to increase without radical new treatments and better ways to prevent antibiotic resistance.
"A post-antibiotic era is difficult to contemplate but might become a reality unless the threat of progressive antibiotic resistance is taken seriously,".WebMD
NEW STUDY FINDS MRSA ON THE RISE IN HOSPITAL OUTPATIENTS; Seven-fold increase in potentially lethal superbug:
The community-associated strain of the deadly superbug MRSA—an infection-causing bacteria resistant to most common antibiotics—poses a far greater health threat than previously known and is making its way into hospitals, according to a study in the December issue of Emerging Infectious Diseases.
New Therapies For Drug-Resistant Staph may Breed Even Worse Mutant Super-Bacteria?
Antibiotic-resistant staph bugs are a terrifying prospect: a potentially deadly skin infection that resists most traditional treatments. MRSA (Methicillin-resistant Staphylococcus aureus) arose as such a threat because it is mutation that is resistant all but the most powerful antibiotics. It can prove lethal if it spreads to your heart or other key organs. But finding stronger treatments against MRSA may not be the best long-term solution — by attacking the bugs with plasma, we may ensure that the mutations that survive will be even tougher. We're effectively breeding Fremen bacteria.
My Message
"Watch what we are up against" - This is not a war of mights but a war of minds, think what the consequences are before you jump into conclusion and start a fighting this battle with bugs that we may never win"
What Is The Problem?
In 1980s we saw rapid proliferation of MRSA infection in Paediatric neonatal units all over UK.The media attention was focused on HIV & AIDS. The problem was wide spread and we have seen various babies who were stable after active resuscitation die due to Staphylococcus infection which was resistant to Methicillin. Consultants started pumping in more toxic antibiotics which are broad spectrum. Soon we were riddled with C Diff, Pseudomonas, Klebsiella and E Coli infections.
In 1989, I saw the first case of a boy aged fourteen years die with severe septicaemia. He was said to be well in the past and was dead within twenty four hours (12 hours after admission). This was shocking experience for me. Blood culture grew Staphylococcus aureus. Not many though this was a major blow to our healthcare profession nor was I given the encouragement to identify causes. As a junior doctor spending more time in the ward I observed an association between increased MRSA infection and multiple attempts to intubate babies. Here I invented ET Tube fixation device and The Spring loaded IV Cannula Introducer. My mission was to reduce the number of extubation and attempts to insert IV Cannula. My contribution was published in medical journals and commended by doctors working in intensive care and anaesthesiologist.
In 2003, the number of death in hospitals due to spreading MRSA started increasing. The media started blaming hygiene standard in hospitals. Without thinking of consequence our ministers spent £Billion to over enthusiastic cleaning our hospital. This heavy handed approach actually killed all the good bacteria and allowed the super bugs to colonize in the sewer. Ignoring microbiologist's advice to restrict use of broad spectrum antibiotics and performing procedures like routine blood tests, inserting cannula and catheters. Strict guidelines to observe aseptic technique based on current thinking was not implementer. Preparing skin and observing drying time was also ignored. Our concern was not taken seriously, nor did the medical journals think it was necessary to publish article which were said to be controversial and so ignored.
Staphylococcus aureus has lived on earth some 2 billion years before the origin of animals and human. They are found in water, soil and air in the universe and are now resistant to biocides, antiseptics, alcohol and antibiotics. They are our companion who lives on our body, hands and nose. These organisms have now gone mad and we have no means of stopping them. They rapidly multiply and are capable of making good bacteria turn vicious. We are now colonised with various bacteria and scientists are finding one new strain practically every day. To understand how these bacteria operate, we may take twenty or more years. As American Academy of Microbiologist say "A War with Antibiotic Resistant Bacteria Is One We Will Never win".
The List I compiled is mainly the group. We have various subclasses in each group. The reason I mention this is because the hospitals say that the incidence of MRSA or C Diff has dropped. This is not true because the tests used can only identify certain strains (groups) and not sub class. The report published is often short duration and confined to single group.
The bacterial infections are also seasonal some multiply in spring and others during autumn and winter. When I look at the over picture using various groups, you can see one infection dominates and the others stay dormant but wake up when initial organism slows down.
We will be kidding our selves if we believe the statistics and headlines published in the news paper. Blaming and shaming hospitals that do not reach target and has higher infection rate seldom help. It's not the hospital at fault but the people who walk in and out and the nurses who are encouraged to squirt alcohol gel to wash their hands. Knowing alcohol is now colonised with resistant strains, we could be introducing resistant bacteria to wound.
The journalists are not scientist nor do they have the in depth knowledge of bacterium, virus and fungus. We have noting to gain from this mission to help educate people. This will not only help people to prevent infection spreading in their family but also make our work easy. It's hard to tell a relative or parents why their loved ones die because they simply cannot accept that we have no treatment that kills these germs.
These bacteria are more virulent and some have up to eight enzymes that can kill a person in few hours. They are capable of spreading fast and especially in crowds. The most important time we need to watch is during Olympics in 2012. Various strains from other countries will be entering UK. I feel this is the time when our lives will be in seriously threatened by bugs.
List of Bugs That Are Resistant to Antibiotics (Updated versions Nov-Dec 2009)
1. Streptococcus pneumoniae
2. Group A Streptococci
3. Enterococci(VRE)
4. Staphylococci aureus (MRSA)
5. Enteric bacilli
6. Haemophilus Influenzae
7. Neisseria gonorrhoea
8. Neisseria meningitis
9. Mycobacterium tuberculosis
10. Pneumococcus
11. Meningococcal infections
12. Mutant Escherichia coli
13. Plasmodium (Malaria)
14. Candida albicans (Thrush)
15. Trichomonas
There is a gap between the burden of infections due to multidrug-resistant bacteria and the development of new antibiotics to tackle the problem.
• Resistance to antibiotics is high among Gram-positive and Gram-negative bacteria that cause serious infections in humans and reaches 25% or more in several EU Member States.
• Resistance is increasing in the EU among certain Gram-negative bacteria such as recently observed for Escherichia coli.
• Each year, about 25 000 patients die in the EU from an infection with the selected multidrug-resistant bacteria.
• Infections due to these selected multidrug-resistant bacteria in the EU result in extra healthcare costs and productivity losses of at least EUR 1.5 billion each year.
• Fifteen systemically administered antibacterial agents with a new mechanism of action or directed against a new bacterial target were identified as being under development with a potential to meet the challenge of multidrug resistance. Most of these were in early phases of development and were primarily developed against bacteria for which treatment options are already available.
• There is a particular lack of new agents with new targets or mechanisms of action against multi drug resistant Gram-negative bacteria. Two such agents with new or possibly new targets and documented activity were identified, both in early phases of development.
• A European and global strategy to address this gap is urgently needed.
Molecular mechanisms that confer antibacterial drug resistance
Christopher Walsh
Biological Chemistry and Molecular Pharmacology Department, Harvard Medical School, Boston, Massachusetts 02115, USA
Nature 406, 775-781 (17 August 2000) | doi:10.1038/35021219
Antibiotics - compounds that are literally 'against life' are typically antibacterial drugs, interfering with some structure or process that is essential to bacterial growth or survival without harm to the eukaryotic host harbouring the infecting bacteria. We live in an era when antibiotic resistance has spread at an alarming rate 1, 2, 3, 4 and when dire predictions concerning the lack of effective antibacterial drugs occur with increasing frequency. In this context it is apposite to ask a few simple questions about these life-saving molecules. What are antibiotics? Where do they come from? How do they work? Why do they stop being effective? How do we find new antibiotics? And can we slow down the development of antibiotic-resistant superbugs?
The Most Dangerous Bacteria
Matthew Herper, 03.01.06, 9:00 AM ET
Athletes with infected scrapes that won't go away. Hundreds of soldiers returning from Iraq with wound infections that don't respond to most antibiotics. Often deadly pneumonias. Ninety-thousand patients who die in hospitals every year. That's the toll in the U.S. from germs that are resistant to existing medicines.
The problem is that many common bacteria and fungi have evolved into being resistant to the drugs that have kept them at bay for a half-century. The problem is not new, but it is still getting worse, even as a spattering of new antibiotics and anti-fungal drugs reach the market. Now, doctors are trying to get more attention for the problem, hoping that comprehensive legislation could stimulate drug firms to put more effort into developing new antibiotics.
Infectious Diseases Society of America, an association of 8,000 infectious-disease specialists, is announcing a hit list of the six most worrisome germs doctors now face in clinical practice. The list, which includes five bacteria and one fungus, is described in the current issue of Clinical Infectious Diseases, a medical journal, and will also be unveiled as part of a press conference today. For all of these germs, the authors see very few new drugs being developed and rising rates of illness.
Multiple Resistance Bacteria that produce Septicaemia and Rapid death
• Staphylococcus aureus, methicillin resistance (MRSA);
• S. aureus, vancomycin intermediate resistance and vancomycin resistance (VISA/VRSA);
• Enterococcus spp. (e.g. Enterococcus faecium), vancomycin resistance (VRE);
• Streptococcus pneumoniae, penicillin resistance (PRSP);
• Enterobacteriaceae (e.g. Escherichia coli, Klebsiella pneumoniae), third-generation cephalosporin
Resistance;
• Enterobacteriaceae (e.g. K. pneumoniae), carbapenem resistance; and
• Non-fermentative Gram-negative bacteria (e.g. Pseudomonas aeruginosa), carbapenem resistance.
Big drug firms have all but given up looking for new antibiotics. Biotechs are filling in.
Are we losing the war against bacterial disease?
The past 35 years have seen only one new class of bacteria-fighting drugs come to market, and a solo entrant at that Pfizer's Zyvox. (Response to Emerging Infection Leading to Outbreak of Linezolid-Resistant Enterococci; CDC) has now been withdrawn by Pfizer's.
Medicine needs new antibiotics more than ever. Drug-resistant strains of everything from tuberculosis to staphylococcus are killing tens of thousands of patients every year. Penicillin is now useless against one-third of all Streptococcus pneumoniae, a common cause of pneumonia, meningitis and ear infections. The cost of treating resistant infections may be as much as $30 billion annually. "There are a number of organisms where we're one antibiotic away from a worldwide disaster," says Hank A. McKinnell, chief executive of Pfizer.
Intensive care units may be breeding grounds for drug-resistant super bugs.
As many as 71% of the world's intensive care patients are receiving antibiotic treatment, which could lead to an increase in drug-resistant super bugs, a new study suggests.
The incidence of ICU infections- particularly bloodborne infections are on the rise, according to researchers from Erasme University Hospital in Belgium. The study surveyed nearly 14,000 patients in 1,300 ICUs in 75 countries around the world. Of those, 51% had some form of infection, most commonly Staphylococcus aureus, the researchers found.
Both the report and the analysis appear in the Dec. 2 edition of the Journal of the American Medical Association.
Salmonella Typhimurium
Bugs in space: genes explain why salmonella grow deadlier when freed from Earth's gravity; by S. Williams; Science News, Sept 29, 2007
When the space shuttle landed, the scientists compared the two sets of pathogens by testing their effects on mice. They found that animals injected with S. typhimurium that had traveled to space died faster than those injected with bacteria that hadn't made the trip.
Salmonella Spills its Secrets on the Space Shuttle
May 6, 2009: Salmonella, what's gotten into you?
Researchers have been asking themselves this question ever since Salmonella Typhimurium bacteria grown on board the space shuttle returned to Earth 3 to 7 times more virulent than Salmonella grown on the ground under otherwise identical conditions. Figuring out why could help safeguard astronauts from disease and lead to new treatments for food poisoning and other common ailments on Earth.
Scientists expose biology of emergent Salmonella
Tuesday, December 1, 2009 14:23 IST
Washington: Scientists have characterised a new multi drug resistant strain of Salmonella Typhimurium that is causing life-threatening disease in Africa. Such type of Salmonella bug normally causes diarrhoea and is rarely fatal.
The new strain, called ST313, infects vulnerable children and adults in many regions of sub-Saharan Africa leading to death in up to one in four cases. The new genome work- a collaboration between the Wellcome Trust Sanger Institute, the Malawi-Liverpool-Wellcome Trust Clinical Research Programme and the Kemri-Wellcome Trust Programme- shows how genetic changes transformed this infection into a new antibiotic-resistant form of the disease.
Research reveals evolution of deadly new Salmonella strain
2 December 2009
The evolution of a new multidrug-resistant strain of Salmonella has been described by Wellcome Trust scientists, increasing our understanding of the life-threatening disease and opening the door to new control and treatment measures.
Kingsley RA et al. Epidemic multiple drug resistant Salmonella Typhimurium causing invasive disease in sub-Saharan Africa have a distinct genotype. Genome Res. 2009 Nov 9. [Epub ahead of print]
Kingsley RA et al. Epidemic multiple drug resistant Salmonella Typhimurium causing invasive disease in sub-Saharan Africa have a distinct genotype. Genome Res. 2009 Nov 9. [Epub ahead of print
EUROPEAN COUNCIL RECOMMENDATION; 9 June 2009
Patient safety, including the prevention and control of healthcare associated infections (2009/C 151/01)
It is estimated that in Member States between 8 % and 12 % of patients admitted to hospital suffer from adverse events whilst receiving healthcare ( 4 ).
The European Centre for Disease Prevention and Control (ECDC) has estimated that, on average, healthcare associated infections occur in one hospitalised patient in 20, that is to say 4,1 million patients a year in the EU, and that 37,000 deaths are caused every year as a result of such infections.
Poor patient safety represents both a severe public health problem and a high economic burden on limited health resources. A large proportion of adverse events, both in the hospital sector and in primary care, are preventable with systemic factors appearing to account for a majority of them.
Population-weighted, average proportion of resistant isolates among blood isolates of
bacteria frequently responsible for bloodstream infections, EU Member States, Iceland and Norway, 2002–2007.
The bacterial challenge: time to react TECHNICAL REPORT
Subsequently, an estimate was made of loss of productivity due to these infections. Based on 2007 data,
Outpatient care costs were estimated at about EUR 10 million and productivity losses due to absence from work of infected patients were estimated at more than EUR 150 million, each year. Productivity losses due to patients who died from their infection were estimated at about EUR 450 million each year. Overall, societal costs of infections due to the selected antibiotic-resistant bacteria were estimated at about EUR 1.5 billion each year.
There are many reasons (e.g. limited range of included bacteria, outpatient infections not being considered,
Fifth Report of the Mandatory Surveillance of Surgical Site Infection in Orthopaedic Surgery: April 2004 to March 2009
Authors: HPA Publication date: December 2009
This report is an analysis of the data collected by NHS Trusts in England during the five years since surveillance of surgical site infection (SSI) following orthopaedic surgery became mandatory in April 2004.
• NHS Trust Tables 2004 - 2009 (PDF, 164 KB)
• Fifth Report of the Mandatory Surveillance of SSI in Orthopaedic Surgery (PDF, 1 MB)
• Mandatory Surveillance of Healthcare Associated Infection Report.2006 (PDF, 774 KB)
Healthcare Associated Infections
The importance of healthcare associated infections (HCAIs) as a cause of preventable illness and death has been recognised increasingly in recent years, and the prevention and control of these infections has become a priority. Surveillance or monitoring of these infections is key to their control: we need to be able to measure them if we are to assess whether any impact has been made on controlling infection. Many hospitals in the country have participated in voluntary surveillance of key infections for many years.
However, as part of the increased focus on control of HCAI, surveillance of some infections was made mandatory. This started off with Staphylococcus aureus (including methicillin resistant Staphylococcus aureus, MRSA) bacteraemia in April 2001 and was later extended to glycopeptide resistant enterococcal bacteraemia in October 2003, C. difficile associated disease in January 2004 and orthopaedic surgical site infection in April 2004. Reports have been published previously, six monthly for MRSA bacteraemia, annually for the other infections.
This information is important as it allows targeting of control efforts on the most affected areas. These developments were implemented in October 2005 and this is the first time this additional information is being published.
•Fifth Report of the Mandatory Surveillance of SSI in Orthopaedic Surgery
•Surveillance of Healthcare Associated Infections Report 2007 (PDF, 466 KB)
•1 December 2009: » NHS Trust Tables 2004 - 2009 (PDF, 164 KB)
•7 September 2009: » Surveillance of Healthcare Associated Infection Report: 2009
Infection Control — A Problem for Patient Safety
John P. Burke, M.D.
Nosocomial, or hospital-acquired, infections (more appropriately called health care–associated infections) are today by far the most common complications affecting hospitalized patients. Indeed, the Harvard Medical Practice Study II found that a single type of nosocomial infection — surgical-wound infection — constituted the second-largest category of adverse events.1 Long considered the greatest risk that the hospital environment poses to patients,2 nosocomial infections abruptly became the province of public health officers at the time of a nationwide epidemic of hospital-based staphylococcal infections, in 1957 and 1958.3 Since then, the study and control of nosocomial infections have been profoundly shaped by the discipline [Full Text of this Article]
Health Protection Agency and Office for National Statistics publish study of deaths following MRSA infection Press release (01/11/2007):
Results of the fifth year of mandatory surveillance of MRSA bacteraemia, including data from the new enhanced surveillance scheme. Mandatory Surveillance of C. difficile associated disease 2005. Mandatory surveillance of surgical site infection in orthopaedic surgery
•MRSA bacteraemia 6-monthly data April 2001 March 2006 (Excel Spreadsheet, 142 KB)
•MRSA bacteraemia annual data April 2001 March 2006 (Excel Spreadsheet, 82 KB)
•Clostridium difficile (Excel Spreadsheet, 172 KB)
• GRE bacteraemia yearly data October 2003 – September 2005 (Excel Spreadsheet, 45 KB)
MRSA and C. difficile continue to fall (Interesting but false)
The Health Protection Agency (HPA) has today published a quarterly epidemiological commentary on trends of MRSA (meticillin-resistant Staphylococcus aureus) bloodstream infections and C. difficile (Clostridium difficile) infections from July 2007 to September 2009.
This report is not something we are excited about because we expect the infection to wax and wane. Over the years we have seen this happen in paediatric department. Antibiotic resistant bacteria is here to stay, various hospitals have started screening patients prior to admission and surgery. If they are found to be positive doctors tend to postpone surgical procedures and operations. This is likely to reduce infection rates and will show the incidence of infection has declined. You can see the result of screening in this report
•Healthcare-Associated Infections in England: 2008-2009 Report (PDF, 1.4 MB)
Microbes Without Borders: Key Facts on Infectious Diseases in Europe - Highlights from ECDC’s annual report on infectious diseases in Europe
Antimicrobial resistance is one of the most serious public health problems, globally and in Europe. If the current rise in Drug resistance among microbes is not halted; mankind will lose one of its most important weapons against infectious diseases.
The problem of drug resistance is complex and results from the over-use or inappropriate use of antibiotic and antiviral Drugs; the spread of drug-resistant microbes, particularly in hospitals, clinics and care centres; and a shortage of new Antibiotic drugs
Antimicrobial Resistance in Europe
Since their discovery, antibiotics have revolutionised the way we treat patients with bacterial infections and have contributed to reducing the mortality and morbidity from bacterial diseases. They are also an essential tool for modern medicine and common procedures such as transplants, chemotherapy for cancer and even orthopaedic surgery could not be performed without the availability of potent antibiotics
Community-Associated Methicillin-Resistant Staphylococcus aureus, Iowa, USA
CDC; Emerging Infections; Volume 15, Number 10–October 2009
We performed antimicrobial drug susceptibility testing and molecular typing on invasive methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 1,666) submitted to the University of Iowa Hygienic Laboratory during 1999–2006 as part of a state wide surveillance system.
All USA300 and USA400 isolates were resistant to <3 non–β-lactam antimicrobial drug classes. The proportion of MRSA isolates from invasive infections that were either USA300 or USA400 increased significantly from 1999–2005 through 2006 (p<0.0001).
During 2006, the incidence of invasive community-associated (CA)–MRSA infections was highest in the summer (p = 0.0004).
Age <69 years was associated with an increased risk for invasive CA-MRSA infection (odds ratio [OR] 5.1, 95% confidence interval [CI] 2.06–12.64), and hospital exposure was associated with decreased risk (OR 0.07, 95% CI 0.01–0.51).
We Cannot Estimate "The Cost of Life"
The Centers for Disease Control and Prevention (CDC) estimates that each year in the United States there are about 1.7 million nosocomial infections in hospitals and 99,000 associated deaths. The estimated incidence is 4.5 nosocomial infections per 100 admissions, with direct costs (at 2004 prices) ranging from $10,500 (£5300, €8000 at 2006 rates) per case (for bloodstream, urinary tract, or respiratory infections in immunocompetent patients) to $111,000 (£57,000, €85,000) per case for antibiotic resistant infections in the bloodstream in patients with transplants. With these numbers, conservative estimates of the total direct costs of nosocomial infections are above $17 billion. The reduction of such infections forms an important component of efforts to improve healthcare safety. (BMJ 2007)
This problem is not unique to one country; the British National Audit Office estimated that the incidence of nosocomial infections in Europe ranges from 4% to 10% of all hospital admissions.
As of early 2005, the number of deaths in the United Kingdom attributed to MRSA has been estimated by various sources to lie in the area of 3,000 per year. Staphylococcus bacteria account for almost half of all UK hospital infections. The issue of MRSA infections in hospitals has recently been a major political issue in the UK, playing a significant role in the debates over health policy in the United Kingdom general election held in 2005.
Worldwide, an estimated 2 billion people carry some form of S. aureus; of these, up to 53 million (2.7% of carriers) are thought to carry MRSA.
In the United States, 95 million carry S. aureus in their noses; of these, 2.5 million (2.6% of carriers) carry MRSA.
A population review conducted in three U.S. communities showed the annual incidence of CA-MRSA during 2001–2002 to be 18–25.7/100,000; most CA-MRSA isolates were associated with clinically relevant infections, and 23% of patients required hospitalization.
This website is for various articles published in medical journals. The information provided at this website is not intended to provide treatment advice, or to diagnose or treat any medical disorder. The creator of this website is not responsible for events that occur as a result of decisions made based on the information presented here
Word Of Caution
If you introduce one superbug in a colony of good bugs, soon all the good bugs will become Superbugs. Alcohol used by nurses to sterlize equipment, prepare skin before surgery and wash hands will introduce superbugs. Higher concentration of Antibiotics used in to boost fermentation technique to produce more alcohol has resulted in antibiotic resistant bacteria colonization in the alcohol.
