Beware of your doctor’s coat sleeves and stethoscope when in the intensive or critical care unit of any hospital. For these are where the deadly multidrug-resistant organisms thrive, which could make the treatment all the more difficult and expensive, and worst, they could be life-threatening.
Intravenous infusions
About 60 % to 70 % of the multidrug-resistant bacterial infections are acquired from the hospital environs where patient’s immunity levels are compromised, and the risk of acquiring an infection from fellow patients is high, say critical care specialists. Intravenous infusions are another potential site for infections, as they are directly pumped into the blood.
“Of the cases of multidrug-resistant bacterial infections we get, 30 to 40 % are community-acquired, while 60 to 70 % are acquired in hospitals. If the community-acquired infections go up to 50 to 60 % in the coming two to three years, we will encounter a serious problem, as no new antibiotics are coming in the next five years,” says Srinivas Samavedam, head of critical care medicine at Virinchi Hospitals, Banjara Hills.
In reply to a question at a press conference organised by the hospital here on Thursday on ‘Hospital-Acquired Infections’, Dr. Samavedam said the encounters with the Carbapenem-resistant bacterial infections are quite often, especially in the cases pertaining to urinary tract infections (UTI) involving Escherichia coli (E-coli) and/or Klebsiella bacteria.
Carbapenems are used for treating infections caused by multidrug-resistant bacteria. The critical priority group of 12 ‘super-bugs’ or antibiotic-resistant bacteria listed recently by the World Health Organization includes three types of gram-negative bacteria namely Acinetobacter, Pseudomonas and various Enterobacteriaceae including Klebsiella, E-coli, Serratia, and Proteus.
They can cause severe and often deadly infections such as bloodstream infections and pneumonia, says the WHO report. All of these bacteria have become resistant to a large number of antibiotics, including Carbapenems.
Drug combination
Colistin, another last-resort antibiotic, is used for the treatment of Carbapenem-resistant bacterial infections. Though rare, there have been patients with Colistin-resistance, to treat whom a drug combination with Polymyxin B-- a highly toxic antibiotic-- will have to be administered, says Dr. Samavedam.
The cost of hospitalisation spiral up for the treatment of any multidrug-resistant bacterial infection.
The minimum required therapy lasts for 10 days, and the patient needs to be monitored closely for a week or more.
“Five days in ICU for patients with severe sepsis and multi-organ failure will cost ₹1.5 lakh, and for many families in India, it is a huge burden. Patients stop the treatment worried about the cost, which is why mortality is high,” Dr. Samavedam says.
He recommends use of IV fluid containers manufactured using German technology, which do not need needle prick for collapsibility, thus precluding transfusion of infection-causing bacteria. Architectural practices which allow abundant daylight into the ICU chambers, isolation of patients with suspected infections, utmost hygiene, and individual attention are a few other suggestions made by the hospital’s senior intensivist Murty V.V.S. Nekkanti.
