Superbugs: an emergency response

The convening of a national public health emergency team is a rare event. It means carbapenemase-producing enterobacteriaceae (CPE), the newest in a long line of superbugs that are hard to kill with antibiotics and are a particular problem in hospitals, will be managed with an urgency equivalent to a severe influenza outbreak.

Known outbreaks have occurred in eight healthcare facilities in the Republic, resulting in prolonged bed closures and significant morbidity and mortality. The Department of Health says CPE poses a risk to patient safety that merits a co-ordinated emergency response. Owing to antibiotic resistance, there are very few therapeutic options with which to treat infected patients. Infection with CPE poses a particular risk to older people and those with reduced immune system function.

The real danger occurs when the bacteria enter the blood stream, with more than half of all patients who develop blood stream infections with CPE dying as a result

CPE are bacteria that are carried in the gut. Of particular concern is that they have become resistant to last-resort drugs called carbapenems. The bugs are shed in faeces and transmitted by direct and indirect contact with an infected person; a period of four weeks or more may elapse between that contact and the time at which CPE becomes detectable in the faeces of the next victim. But the real danger occurs when the bacteria enter the blood stream, with more than half of all patients who develop blood stream infections with CPE dying as a result.

CPE is the latest threat to emerge as a result of anti-microbial resistance, with the number of CPE cases in Ireland almost doubling last year. A 2007 report estimated drug-resistant bacteria were responsible for about 25,000 human deaths a year in the EU, with associated healthcare costs and productivity losses of €1.5 billion. In the region of four million patients are estimated to acquire a healthcare-associated infection in the EU every year. There is still an opportunity for effective intervention by the State to protect patients and to prevent widespread hospital ward closures as a result of CPE. That opportunity must be grasped.