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Hospitals on superbug front line

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Hospitals will become the frontline of efforts to detect and control deadly superbugs amid warnings rising antibiotic resistance threatens to make even simple infections potentially deadly.

A government-appointed infection control taskforce has recommended that all hospitals take part in a nationwide screening program to detect patients carrying carbapenem-resistant Enterobacteriaceae (CRE).

The call follows warnings from the Office of the Chief Scientist (OCS) that superbugs pose a major health threat.

In a paper released last month, the OCS said the rise of antibiotic resistant infections and dwindling investment in research had left the community badly exposed to the risk of deadly outbreaks.

The Multidrug Resistant Gram Negative Taskforce has drawn up a set of guidelines to help control the spread of CREs, which health authorities warn could make even mild and routine infections such as a sore throat deadly.

Taskforce member Associate Professor John Ferguson told an Australasian Society for Infectious Diseases conference that virtually all the major international strains of carbapenem resistance, including the virulent New Delhi metallo-beta-lactamase-1 (NDM-1), have been detected in Australia, though they remain relatively rare.

NDM-1 and the similar IMP-4 are genes that render bacteria such as Escherichia and Klebsiella pneumoniae resistant to carbapenem and other penicillin-type antibiotics.

Associate Professor Ferguson, who is Director of Infection Prevention and Control at Hunter New England Health, said patients infected with CRE were in danger of developing septicaemia and other serious infections that had high mortality rates.

He said it was important to act quickly to control the spread of CRE while it remained relatively uncommon.

“The Taskforce believes that implementation of consistent CRE control measures at this early stage is critical,” he said. “If CRE is allowed to spread unchecked, then the number of patients with serious, including fatal, infections due to CRE will increase [and] subsequent control measures will become much more difficult.”

The Taskforce, in consultation with Dr Cate Quoyle from the Australian Commission for Healthcare Safety and Quality, has developed guidelines to reduce the risk of CRE infection, improve detection and surveillance and suppress cross-transmission.

In particular, it has recommended hospitals begin active screening to detect several categories of at-risk patients, including those admitted to or transferred from an overseas hospital in the preceding 12 months, those who have had tested positive for CRE and are yet to test negative, and patients with a history of CRE infection.

“All hospitals will have to implement systematic questioning of patients at triage or during the admission process,” Associate Professor Ferguson said, urging that a nationally consistent approach be considered.

The Taskforce’s recommendations, which are due to be finalised later this year, came as the OCS said the widespread and indiscriminate use of antibiotics, including over-prescribing and for treating viral infections, had fuelled the growth of resistance.

This had been coupled with a dramatic slowdown in the discovery of new antibiotics.

“The rise in bacterial resistance has coincided with a collapse in the antibiotic discovery pipeline,” the OCS paper said. “Only one antibiotic that works in a novel way has been discovered and developed for use in humans in the last 50 years.”

It said most companies had either abandoned the field or were cutting back on their investment.

“There is now a genuine threat of humanity returning to an era where mortality due to common infections is rife,” the OCS said. “Nothing short of a global revival in antibiotics R&D is required. It is critically important that we build up a new arsenal of effective treatments and diagnostic tools to combat resistance in the longer term.”

Adrian Rollins