Hospital Acquired Infections - A Bad News Day

Rosa Kleb, one of the more evil masterminds of Flemings curious and sinister world is not responsible for Klebsiella pneumoniae. This talented microbe was named after the famous German pathologist (one of many in the last century) Edwin Klebs (1834–1913) who worked with Rudolf Virchow at the Pathological Institute in Berlin from 1861 until 1866. His main claim to fame is his identification of the bacterium Corynebacterium diphtheriae as the aetiological cause of diphtheria. The bacterial genus Klebsiella is named in to honour him.

Klebsiella pneumoniae (KP) is a bacterium normally found in the mouth, skin and intestines. Strains resistant to antibiotics are being found with increasing frequency in hospitals. KP causes bacterial pneumonia, it is commonly involved in hospital-acquired wound and urinary-tract infections, particularly in patients with weak immune systems, especially the elderly - the same group who are susceptible to other HAI's such as Staphylococcus aureus.

Faeces are the most significant source of infection, followed by contact with contaminated instruments, catheters, speculums, colonoscopes. Therefore strict regimes of hand washing are required by anyone who handles patients.

Early in March there were reports on Israeli TV that apparently KP killed more than 100 very sick patients in a number of hospitals around the country and sensational charges of a cover up against the Health Ministry were made.

It soon became apparent that the problem was more serious than was at first reported.

Responding belatedly the Ministry of Health appointed Prof. Yehuda Carmeli, a leading epidemiologist at Tel Aviv's Sourasky Medical Center, to head a team, to deal with an outbreak whose scale had been previously not made public.

“Between 400 to 500 people have been infected by the bug, and 30 to 40 percent of them have already died,”

said Yehuda Carmeli, the head of the epidemiology unit at the Sourasky Medical Center in Tel Aviv.

“However, it is important to note that most of them were in a serious condition, and some were suffering from prior medical conditions.”

The Ministry said later that most of those infected have been hospitalized for over 25 days, and their average age was about 75. It appears that the organism is resistant to third generation cephalosporins and the latest aminoglycosides of the Streptomycin family. It appears that KP has a neat trick of producing a mutant that produces an enzyme known as "extended-spectrum beta lactamases," or ESBLs which allows them to hydrolyze cephalosporins. 2 New York hospitals report 25% of infections with this refined biochemistry. The Sourasky Medical Center laboratory has expertise in molecular typing of bacterial pathogens, genetic analysis of mechanisms of antibiotic resistance, including beta-lactamases and collaborate with several international groups on the study of antibiotic resistance. ( Carmeli has identified Acinetobacter baumanii as a newer and possibly more dangerous antiobiotic resistant organism - Israel hospital report- see Footnote)

Although Health Ministry Director-General Professor Avi Yisraeli told reporters only very ill patients in hospitals are at risk, the public reacted to the news reports of the infections by avoiding hospitals altogether. Emergency rooms in Israeli hospitals emptied,leading doctors and the Health Ministry to warn of the dangers of avoiding treatment when necessary.

Riding on the back of this, Avi Yisraeli seized the opportunity to tackle Prime Minister Olmert to ask for 2.5 million shekels (US$600,000) of emergency funding to control the infection, and to invest in three new hospitals by 2015. At the time, Ben-Yizri told the Prime Minister that hospitals are in immediate need of an additional 3,000 beds - there are no reports about how successful he was.

It appears that Israel is the only country outside the US to have reported widespread antibiotic-resistant strain of Klebsiella although very isolated cases have been reported as widely as Thailand. the Czech republic and Hangzou in China. The emergence of multi-drug resistant Klebsiella will become a global concern just as MRSA's have ,and increasingly Multiple Drug Resistant TB's (MDRTB) have been invading the EU from eastern Europe and Russia whose prisons are a huge and potent resevoir of HIV / TB - the peristent habit of health autorities to conceal the problem from the public only hinders the resolution of the problem.... unless of course the policy is to kill off the old and save on their pension benefits.

For an example go to these 2 rports today at BBC Online (Outbreak details Costs of clean up) about the Clostridium difficile outbreak in the James Paget Hospital in Gorleston, Norfolk which occurred between December and March and resulted in 17 deaths. This has just been disclosed and will involve costs of £400,000 to sterilise this one hospital. There were 2 previous outbreaks of the same organism at Stoke Mandeville between October 2003 and June 2005, and overall 334 patients were infected and at least 33 died in this period. An enquiry ordered by Patricia Hewitt that reported last June said that ther may have been up to 65 fatalities.

Cases of C. difficile infection in patients aged 65 years and above increased by 17.2% in England over the last year, from 44,107 in 2004 to 51,690 in 2005, (Source Health Protection Agency.)
The Healthcare Commission's inquiry (June 2006) into the Stoke Mandeville outbreak identified failings by the senior managers at the hospital, which forms part of the Buckinghamshire Hospitals NHS Trust.

It said they failed to follow advice on stopping the spread of infection, even at the height of the outbreak, from infection control staff, clinicians, nurses, and the Health Protection Agency and failed to learn lessons after the 1st outbreak.

The report said they were too busy focusing on other areas, such as meeting government targets and finance control.

In other words they were more concerned about controlling cash than disease... which we find throughout the world results in perfect cash control ... and rampaging lethal, and often fatal infections.

FOOTNOTE

Acineobacter baumannii has it's own website somewhat sensational it does appear that this is a major problem with soldiers returning from medical treatment in Gwermany after wounding in Iraq and Afghanistan ....

Early this year an outbreak of MDR Acinetobacter baumannii swept over Arizona, 236 cases in just 2 months. It was reported by the state disease monitoring systems, but ignored on the national level.This outbreak that is spreading nation wide is largely due to the war in Iraq, and because of a legal technicality in reporting, the military and CDC will not disss it publicly. More people come forward, bit by bit, telling stories of how the hospital played down their infection. The one person who could have done something about it, "Rep. Dennis Moore" has walked away from the issue deciding it wasn't worth getting into even after what he had seen on a visit to Walter Reed.Acinetobacter baumannii infections among patients at military medical facilities treating injured U.S. service members, 2002-2004.

Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center.

The CDC reported reported an increasing number of A. baumannii bloodstream infections in patients at military medical facilities in which service members injured in theoperations in Iraq and Afghanistan in 2004. A. baumannii survives even on dry surfaces for up to 20 days, and so constitutes a high risk of spread and contamination in hospitals, putting immune-compromised and other patients at risk for drug resistant infections that are often fatal and generally expensive to treat. (there is increasing evidence that smokers with COPD are especially prone to infection).

See this for news of "adverse events" in UK hospitals...if you can find it , also read Ivan Illych LIMITS TO MEDICINE. Medical Nemesis: The Expropriation of Health. London. Calder and Boyars. Ideas in Progress 1976. The first sentence of which is "'The medical establishment has become a major threat to health'. he also identified the habit of the medical / pharma nexus to "medicalise" problems which has led to the more modern blight of "Disease Mongering".Got a pain in your foot ... well you may have "painful foot syndrome." .. You think this is a joke , 3 million Australians are said by one Oz medical luminary to suffer from "restless leg syndrome".. and will prescribe you a pharmaceutical treatment.