A woman in her 70s who died of septic shock in Nevada in early September last year was killed by a superbug infection she got during multiple hospitalisations in India last year, confirmed the US Centers for Disease Control (CDC) and put the spotlight on infection-control in hospitals in India.
The woman’s infection was so deadly that it was resistant to 26 different antibiotics, including polymixins and tigecycline, to potent drugs designed to treat highly-resistant infection.
She was admitted to a hospital in Reno, Nevada, with carbapenem-resistant enterobacteriaceae (CRE) infection that do not respond to the potent carbapenem class of antibiotics, which are among the last resort to treat drug-resistant infections. She developed systemic inflammatory response syndrome that could not be treated with the 14 powerful antibiotics she was precribed.
The infection was caused by the Klebsiella pneumonia bacteria, which is found in the normal flora of the mouth, skin, and intestines but become deadly when they enter the bloodstream.
The US CDC confirmed the resistance was caused by the presence of New Delhi metallo-beta-lactamase (NDM-1), an enzyme that directly breaks down carbapenems, a powerful class of antibiotics used to treat multidrug-resistant infections.
The woman had been in India for two years and had been hospitalised at least four times for a right femur fracture and a subsequent hip fracture.
CRE have been labelled as a “nightmare” bacteria not only because they are already resistant to most antibiotics, but also because they spread easily in hospital settings.
Hospital safety in India
How safe are hospitals in India, where antibiotic misuse and overuse is rampant among patients, livestock owners and quacks.
“It’s not a problem unique to India. Misuse because of self-medication, non-compliance to the full course for the indication being treated and using strong antibiotics when simple ones are needed all lead to resistance, where antibiotics are anyway misused to feed livestock,” said laparoscopic and bariatric surgeon Dr Pradeep Chowbey, executive vice-chairman, Max Healthcare Group. “As doctors, we have to follow sterilisation -- such as plasma sterilisers, Ethylene Oxide (EtO) and autoclaving -- and prescription protocols to ensure antibiotics are used correctly,” he said.
“All accredited hospitals adhere to 20 standards and 68 measurable elements for infection control as part of international accreditation to ensure hospital-associated infections don’t occur,”’ said Dr Anupam Sibal, group medical director, Apollo Hospitals Group that runs 66 hospitals across India. “Some antibiotics, for example, have such restricted use that only infection-control departments can prescribe them.”