Superbugs crawling their way out of hospitals

Drug-resistant strains that have a high mortality rate — cases of which were usually seen among people that had recently been to a hospital — are now spreading to people who have had no contact with any healthcare centre for over three months, a recent study has revealed. 

The author of the study said: “The distinction between community-acquired and hospital-acquired infections is becoming increasingly blurred. The main reasons for this are the spread of classically ‘hospital’ strains, particularly resistant Klebseilla and E. Coli, into the community and vice versa, and the repeated admission of individuals to hospitals with long-standing underlying diseases.

Building resistance

“In addition, the contribution of antibiotic resistance to the community through easily available antibiotics often used without medical supervision has resulted in an increasing reservoir of potential infections,” said the Dr. 

He added that resistance to high-end antibiotics by organisms contracted by patients in the community “is a cause for worry and needs further research and proper action plan”.

Infections due to multi-drug resistant organisms have become a serious health concern worldwide.
The study — Association of high mortality with extended-spectrum Beta-lactamase (ESBL) positive cultures in community acquired infections — was conducted to investigate the spectrum of microbial resistance pattern in the community and their effects on mortality.

The study notes that infections due to multi-drug resistant organisms, particularly those producing extended-spectrum Beta-lactamases, are of major concern worldwide.

New generation

ESBLs are organisms that are resistant to various newer-generation antibiotics and can be easily transferred to the community.

These resistant infections pose therapeutic challenges to clinicians in the treatment of these patients and may therefore be associated with high morbidity and mortality.

“The striking point noted in our results is the emergence of E.coli as most common bacteria in the community causing bacteraemia, respiratory and urinary tract infection and higher mortality in ESBL positive producers as compared to ESBL negative producers,” said the Dr. 

Among the 201 patients studied, 63.44% who contracted E. coli were ESBL producers.

Trickling into society

This reflects the increased resistance pattern to high-end antibiotics in Hospital-Acquired Infections due to inadvertent early use of third-generation Beta-lactam antibiotics, such as cephalosporins, which is further trickling over into the community because of “plasmid mediated transfer of its genetic materials during conjugation”, noted the study. 

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Superbugs hinder kidney infection treatment

Increase in antibiotic-resistant bacteria or superbugs is making it more difficult to treat a common but severe kidney infection, a new study has found. 

Pyelonephritis - infection of the kidney usually caused by E coli bacteria and which can start as a urinary tract infection - causes fever, back pain and vomiting.

About half of people infected require hospitalisation. If not treated with effective antibiotics, it can cause sepsis and death, researchers said. 

In the study led by researchers at University of California, Los Angeles (UCLA) based on data from 10 large hospital emergency departments around the US, almost 12 per cent of people diagnosed with pyelonephritis had infections resistant to the standard class of antibiotic used in treatment - fluoroquinolone. 

That is up from 4 per cent in a similar study conducted a decade ago, researchers said. 

In some cities, and among some people with certain risk factors  such as international travel or recent hospitalisation or treatment with an antibiotic  fluoroquinolone resistance rates exceeded 20 per cent. 

The study also documented the emergence of infections caused by a specific strain of E coli that is resistant to additional types of antibiotics, severely limiting treatment options. 

That strain, dubbed ESBL for the antibiotic-destroying enzymes it produces (extended-spectrum beta-lactamases), was not detected in the previous study. 

The enzymes were first detected in 1979 and are most often found in developing nations, researchers said. 

Currently, there are only a few intravenous antibiotic options to treat ESBL-related infections, and no oral antibiotics that are consistently effective, they said. 

"This is a very real example of the threat posed by the emergence of new antibiotic-resistant strains of bacteria, which greatly complicates treatment of infection," said Dr David Talan, the study's lead author. 

The study included 453 people diagnosed with kidney infection. The participants were diagnosed between July 2013 and December 2014 in 10 emergency departments at large hospitals. 

Talan and his colleagues recommended the development of new medications and new guidelines calling for treatment with different types and combinations of antibiotics.

The study was published in the journal Emerging Infectious Diseases.

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