Hospitals urged to stockpile 'last-resort' antibiotics as superbug numbers boom

Hospitals urged to stockpile 'last-resort' antibiotics as superbug numbers boom

Originally published on Stuff

New Zealand is facing a superbug "epidemic", with more people identified as carrying drug-resistant organisms than ever before. 

On Wednesday, Counties Manukau Health announced about 600 patients would need to be tested for a multi-drug resistant organism after potentially coming in contact with a patient who tested positive while at Middlemore Hospital in south Auckland.

In a statement, Counties Manukau Health said it was contacting 200 haematology day-stay patients who could have come into indirect contact with the patient between March 6 and July 5.

The patient was identified as carrying a carbapenem-resistant organism (CRO). Carbapenems are a powerful group of antibiotics which are used to treat infections where other antibiotics have failed. 

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There have been 34 cases of CRO in people across New Zealand year to date, new ESR figures show.

 

ESR, the Institute of Environmental Science and Research, is contracted by the Ministry of Health to collect information about all cases of CRO infections in New Zealand.

Broken down, 11 CRO cases were identified at Middlemore Hospital alone this year, 12 in the wider Auckland region, and 11 across the rest of the country.

It's already the highest annual rate of CRO detection in New Zealand ever, and it's only August.

"We're basically at the beginning [of an] epidemic," microbiologist Dr Siouxsie Wiles said.

There are very few antibiotics which can treat infections with CRO, and in extreme cases no antibiotics are effective.

According to ESR reports, in 2017, 33 new patients tested positive for CRO across New Zealand.

In 2016 there were 38 and in 2015 there were 29.

Between 2009 and 2014, there was an average of about six per year.

"We've had the first cases in 2009, where we've seen one or two cases filtering around for a few years . . . and then we we hit 2015, boom. This is exactly what an epidemic curve looks like," Wiles said.

Both people who were colonised with the resistant bacteria and those infected with it were included in the report – and there was a big difference between the two, she said. 

Those who are 'colonised' are passive carriers, where the resistant bacteria can be found on the skin or in the gut. 

If the bacteria enters the bloodstream or lungs, the patient can become infected and could experience symptoms of an illness that are very hard to treat, she said.

In February, Middlemore Hospital issued an alert limiting admissions to its National Burns Centre due to the spread of a CRO strain. 

Canterbury District Health Board clinical director of microbiology Joshua Freeman said there had been a "exponential" increase in antimicrobial resistance in recent years, which was expected to continue.

He was pleased to note the Ministry of Health had made a commitment to develop a national antimicrobial resistance plan by the end of the year. 

Freeman said a collection of microbiology authorities had made a submission of minimum requirements the national plan should include.

That included a recommendation that public and private hospitals should have timely access to, or even stockpile "last-resort" antibiotics, which Freeman said were difficult to access and sometimes expensive.

"It's rare to get this level of consensus and it reflects how seriously the threat of [CRO] is being taken by expert bodies that understand the threat to healthcare in New Zealand," Freeman said.

MIDDLEMORE TO TEST PATIENTS

Infectious diseases consultant David Holland said Middlemore was taking a "pragmatic" approach in contacting all 200 people who attended the clinic. 

"While there is only a very small risk that they may have acquired this organism, we are taking a precautionary approach to ensure that those who may have come into contact with the patient are checked and we can rule out any possibility that they have CRO," Holland said. 

The screening involves a rectal swab.

"We will have results from the test within a few days but it will take some time to collate all of the results and advise everyone," Holland said. 

A further 400 patients who attended the day-stay clinic during the same period, but not necessarily on the same day as the infected patient, would also be contacted and screened. 

Holland said there were measures in place designed to manage and prevent the spread of CRO and the majority of patients and the public were not at risk.

"Patient safety is paramount and that is why we are taking the extra step of informing and screening to ensure that the organism is contained and managed."

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