Antibiotic-resistant bacteria outbreak exposed
The head of Maasstad Hospital resigned in September amid revelations the facility covered up a n outbreak of antibiotic-resistant bacteria. Investigating the fatal discovery, JOEP DERKSEN uncovers uncertainty about the effectiveness of antibiotics.
How long can a hospital hide the presence of a multi-resistant bacteria? The Maasstad Hospital managed to do this for seven months, a cover-up that was responsible for the infection of hundreds of patients and the death of three people.
The hospital's Chairman of the Board of Directors Paul Smits resigned in September as a result of the outbreak and the hospital has been occupied with damage control. But the country has since been gripped with questions over how far-reaching the outbreak had become and its implications for the future of mankind's health.
The bacteria in question, Klebsiella Oxa-48, is a variant of the Klebsiella pneumonia bacterium. Its presence in the intensive care department of the Maasstad Hospital was first discovered in October of last year. This particular bacterium can be found in the intestines of both humans and animals. But it is considered especially dangerous when it causes tracheal infections as it is immune to all types of antibiotics.
For months the Maasstad Hospital kept silent about the bacteria's discovery, but the truth came out after one infected patient was transferred to the Slotervaart Hospital in Amsterdam. There, the presence of the resistant bacterium was revealed. After the news broke, Smit came forward to say that infected patients were put into quarantine and both personnel and patients had been checked for signs of the bacteria. Since 18 July no additional infections were reported, but by that time the bacterium had claimed many victims already.
In an official declaration, the Maasstad Hospital said, “We regret that patients have been infected with the Klebsiella Oxa-48 bacterium. In total, 28 patients carrying the bacterium have passed away. From a medical research file it has been determined that three patients most likely died as a direct result of Klebsiella infection. We realise the consequences of this conclusion and will do our utmost to relieve the grief of the relatives.”
In September the Maasstad Hospital set up a Committee of Truth (Commissie Waarheidsvinding), under the supervision of prof. dr. W. Lemstra. Only external experts have been appointed to the committee, which is investigating how the outbreak could have occurred. The committee will also examine the responsibilities of all those involved. Results of their investigation are expected in early 2012.
Frighteningly, the Maasstad story is not unique. Bacteria outbreaks have happened in hospitals in other parts of the country as well. Jan Kluytmans, chairman of the Committee for the Prevention of Infectious Diseases (Werkgroep infectieziektenpreventie, WIP), confirms that bacteria cannot be prevented from entering hospitals. “But it is important that the presence of the bacteria is recognised very soon. When a resistant type of bacteria is found, the patient needs to be isolated, then the hospital should check whether the bacterium has spread to other patients and the surroundings should be cleaned and disinfected.”
Luckily, most bacteria present in hospitals are harmless to healthy people. However, the risks can be bigger with people who are already ill. Not only because of their low level of resistance, but also due to the invasive procedures carried out in hospital. “During an operation, bacteria from outside can enter the blood stream. This can cause an invasive infection and blood poisoning,” Kluytmans explains.
Yet he maintains this is a normal risk for hospitals. The more important thing to consider, according to him, is the rate at which bacteria are becoming resistant to antibiotics. Penicillin, for instance, was used in 1940 with an effectiveness of almost 100 percent. Now, more and more strains of bacteria are resistant to the antibiotic as well as other, previously well-functioning types of medication. “The way bacteria have become resistant has gained momentum in an incredible way. The progression is developing so that we have the end in sight of the availability of effective medicine.”
With these disturbing words, Kluytmans explains how the over-intensive usage of antibiotics has allowed different types of bacteria sufficient time and possibilities to adapt. This situation poses another problem: it may no longer be sufficient to come up with new medications as many are a variation of existing pills, powders and liquids.
Thus, the answer to humanity’s future healthcare may lie deep in the rain forests of Brazil, Suriname or Thailand. “This has been very effective, but that source has been drained considerably,” says Kluytmans. “We have searched the jungle a lot, but we may have to consider going back with the hopes of finding new, unexploited areas.”
Should we be worried? Will a killer bacterium, for which no cure is known, soon kill thousands, millions or billions of people? “We have to limit the risks in hospitals as much as possible. If we can do that, the damage can be controlled,” says Kluytmans. But if more bacteria become resistant, the only hope for the future will be in the development of new antibiotics, something Kluytmans does not expect to see in the next 10 years. But he remains optimistic: “On the bright side, this prospect can change any day.”
How long can a hospital hide the presence of a multi-resistant bacteria? The Maasstad Hospital managed to do this for seven months, a cover-up that was responsible for the infection of hundreds of patients and the death of three people.
The hospital's Chairman of the Board of Directors Paul Smits resigned in September as a result of the outbreak and the hospital has been occupied with damage control. But the country has since been gripped with questions over how far-reaching the outbreak had become and its implications for the future of mankind's health.
The bacteria in question, Klebsiella Oxa-48, is a variant of the Klebsiella pneumonia bacterium. Its presence in the intensive care department of the Maasstad Hospital was first discovered in October of last year. This particular bacterium can be found in the intestines of both humans and animals. But it is considered especially dangerous when it causes tracheal infections as it is immune to all types of antibiotics.
For months the Maasstad Hospital kept silent about the bacteria's discovery, but the truth came out after one infected patient was transferred to the Slotervaart Hospital in Amsterdam. There, the presence of the resistant bacterium was revealed. After the news broke, Smit came forward to say that infected patients were put into quarantine and both personnel and patients had been checked for signs of the bacteria. Since 18 July no additional infections were reported, but by that time the bacterium had claimed many victims already.
In an official declaration, the Maasstad Hospital said, “We regret that patients have been infected with the Klebsiella Oxa-48 bacterium. In total, 28 patients carrying the bacterium have passed away. From a medical research file it has been determined that three patients most likely died as a direct result of Klebsiella infection. We realise the consequences of this conclusion and will do our utmost to relieve the grief of the relatives.”
In September the Maasstad Hospital set up a Committee of Truth (Commissie Waarheidsvinding), under the supervision of prof. dr. W. Lemstra. Only external experts have been appointed to the committee, which is investigating how the outbreak could have occurred. The committee will also examine the responsibilities of all those involved. Results of their investigation are expected in early 2012.
Frighteningly, the Maasstad story is not unique. Bacteria outbreaks have happened in hospitals in other parts of the country as well. Jan Kluytmans, chairman of the Committee for the Prevention of Infectious Diseases (Werkgroep infectieziektenpreventie, WIP), confirms that bacteria cannot be prevented from entering hospitals. “But it is important that the presence of the bacteria is recognised very soon. When a resistant type of bacteria is found, the patient needs to be isolated, then the hospital should check whether the bacterium has spread to other patients and the surroundings should be cleaned and disinfected.”
Luckily, most bacteria present in hospitals are harmless to healthy people. However, the risks can be bigger with people who are already ill. Not only because of their low level of resistance, but also due to the invasive procedures carried out in hospital. “During an operation, bacteria from outside can enter the blood stream. This can cause an invasive infection and blood poisoning,” Kluytmans explains.
Yet he maintains this is a normal risk for hospitals. The more important thing to consider, according to him, is the rate at which bacteria are becoming resistant to antibiotics. Penicillin, for instance, was used in 1940 with an effectiveness of almost 100 percent. Now, more and more strains of bacteria are resistant to the antibiotic as well as other, previously well-functioning types of medication. “The way bacteria have become resistant has gained momentum in an incredible way. The progression is developing so that we have the end in sight of the availability of effective medicine.”
With these disturbing words, Kluytmans explains how the over-intensive usage of antibiotics has allowed different types of bacteria sufficient time and possibilities to adapt. This situation poses another problem: it may no longer be sufficient to come up with new medications as many are a variation of existing pills, powders and liquids.
Thus, the answer to humanity’s future healthcare may lie deep in the rain forests of Brazil, Suriname or Thailand. “This has been very effective, but that source has been drained considerably,” says Kluytmans. “We have searched the jungle a lot, but we may have to consider going back with the hopes of finding new, unexploited areas.”
Should we be worried? Will a killer bacterium, for which no cure is known, soon kill thousands, millions or billions of people? “We have to limit the risks in hospitals as much as possible. If we can do that, the damage can be controlled,” says Kluytmans. But if more bacteria become resistant, the only hope for the future will be in the development of new antibiotics, something Kluytmans does not expect to see in the next 10 years. But he remains optimistic: “On the bright side, this prospect can change any day.”
Verschenen in de oktobereditie 2011 van The Holland Times.
posted by Joep J.B. Derksen @ 6:18 a.m.
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