Hospital infections ‘stabilise’

Hospital infections ‘stabilise’

AUSTRALIA has largely escaped a deadly infection that stalks American and European hospitals, maiming and killing people admitted for minor operations.

But experts warn we may not be so lucky next time, with Australia’s remoteness offering little protection against bugs that can travel around the world in hours.

University of Western Australia researchers say the incidence of Clostridium difficile infection, which kills an estimated 14,000 people a year in the US alone, may have plateaued in Australia.

In the first national study of CDI, published today in the Medical Journal of Australia, the researchers found infections had risen by almost a quarter in the year after a widespread hospital monitoring program was established in 2011.

But cases stabilised the following year, leading infectious disease specialists to suggest Australia may have dodged a bullet.

“Fortunately, and perhaps because we were forewarned, we have not experienced waves of severe CDI spreading through our hospitals,” Melbourne academics Paul Johnson and Rhonda Stuart wrote in an MJA editorial.

But they warned that Australia could no longer rely on the geographic isolation that had helped spare the country the worst of pandemics like the Spanish flu. “People and perishable goods arrive every hour from everywhere,” they said. “From the public health perspective, there is less chance now of keeping emerging pathogens out of Australia, particularly if they are carried in the gastrointestinal tracts of healthy travellers returning from overseas.”

CDI has afflicted hospital patients around the world for the past decade, moving in and causing severe diarrhoea after antibiotics kill off beneficial bacteria in the gut. Around 1 per cent of victims need to have their bowels removed and some of those die anyway.

Infections in England plunged from about 53,000 in 2007 to 17,000 in 2011, according to the National Health Service. But a virulent new strain has sent the incidence soaring in the US. “It doesn’t seem to be slowing down any time soon,” said Keith Kaye, an epidemiologist with Wayne State University in Detroit.

Co-author Thomas Riley said he was worried about US-style strains finding their way into Australian hospitals from infections in the wider community. “If they get into the hospital system we’ve got a much more susceptible population,” he said. “That’s when you get really high mortality rates.”

In a separate study, researchers have found golden staph infections halved in Victorian hospitals in the three years after a hospital monitoring scheme was introduced in 2010.

The study, also published in MJA, found that the rate of “healthcare-associated” infections had fallen from 1.4 to 0.7 cases for every 10,000 days patients spent as hospital inpatients. It found that 42 per cent of golden staph infections had been picked up in hospitals, two-thirds of them within two days of hospitalisation.

 

Source: The Australian

 

This is unfortunately a bulletin in a long ongoing and yet to be solved problem. Unfortunately, it illustrates a fundamental difficulty – actually two.

The first is that placing many sick people together in one environment makes for an ideal breeding ground for infective problems like this, particularly when the immune system of many is also compromised. The immune system and its support is not considered a primary feature here; instead the attention is adversarial, toward eradication of any infection, which makes for an ongoing war as the bugs mutate to combat newer antibiotics. Unfortunately the ‘not so ill’, and others in hospital for different reasons – having babies, or routine procedures, for example – could become caught up in the problem.

The second is a more fundamental conflict in the modern medical paradigm, where infections are seen externally and in the aforementioned adversarial context, rather than looking at issues like how over-cleanliness may actually be adding to the problem, rather than reducing it, and that the immune status of any patient is not the primary factor taken into account. And even when it is, the standard approach to immunological problems is often equally adversarial.

These are just some of the factors in a complex and ongoing problem, we are sure more will emerge and that there will be many more chapters in this unfortunate tale.