Experts red-flag ‘superbug’ menace stalking hospitals
Drug-resistant fungal infections are said to be on the rise, particularly in private Gauteng hospitals
An average of between 60 and 80 cases of drug-resistant fungal infections are detected in SA every month, mainly in Gauteng private hospitals, according to the National Institute for Communicable Diseases (NICD).
“I must be honest, these infections are of great concern. It is a worrying situation,” said Prof Nelesh Govender, the NICD head of the centre for healthcare-associated infections, antimicrobial resistance and mycoses.
Govender was speaking after The New York Times reported on the worldwide rise of candidia auris infections, naming four countries where outbreaks had been reported, including SA.
The germ is resistant to at least one class of medication and infects the sickest people in hospitals.
Govender said the NICD had been monitoring these fungal infections in SA through laboratory data since 2009.
He told Times Select an average of 60 to 80 such cases were reported in the country every month, with Gauteng – mainly private hospitals in Johannesburg and Pretoria – the most affected.
Once the fungus was inside a hospital it lived on surfaces and was very difficult to get rid of and could become resistant to some cleaning agents.
In about a third of these cases infection spread to the bloodstream, and four in 10 of those patients died. Those who contracted it were already very ill since mainly patients with a compromised immune system were affected.
Other risk factors in SA included old age, having a central line (a catheter into a large vein) and staying in an intensive care unit for a long period.
Govender said that while it was a fungal infection, antibiotic-resistant infections caused by bacteria are often taken more seriously.
“Antibiotic resistance has been discussed at the World Health Assembly.”
It was the first time in history that a fungal infection had started behaving like an antibiotic-resistant bacterial infection.
“Classically, fungi don’t behave in this way. We have not seen this pattern of disease caused by a fungus before.”
Like bacterial infections, Govender said it was is easy to transmit from one person to another in a hospital. A patient could spread the fungus to the bed, bed linen, hospital curtains and window sills.
“If it contaminates environments and if you don’t disinfect the room, the next patient admitted to the room could potentially contract it.”
The New York Times reported on an outbreak in SA in 2016, but Govender said hospital outbreaks did occur from time to time. There had been an outbreak among four newborns in a private hospital at the end of 2017.
“NICD took this very seriously, going into the hospital to conduct an investigation, as they didn’t want it getting a foothold in neonatal intensive care units, with newborn babies.”
In 10 years in SA, the NICD has only detected two strains that are resistant to three types of medicines (triply resistant), leaving almost no treatments.
Most infections in SA are only resistant to the first class of drugs to treat them but respond to other medications.
“This is the silver lining, I guess,” said Govender.
Experts have just completed guidelines on the best way to manage such infections, but these are not yet publicly available.
Govender said there was a theory that the first infections in SA occurred in Gauteng hospitals.
“The first infections may have been in Gauteng private hospitals. Once it has established a foothold in a hospital it is very difficult to get hold of.
“Private hospitals have more ICU beds, so it may biased in that way. We don’t know for sure.”
Wits professor and intensive care expert Guy Richards said the infection occurred more commonly in hospitals where doctors may use more broad-spectrum antibiotics that do not target specific bacteria.
“These kill all good bacteria too and then you have an invasion of other organisms.”
The most important way to prevent the infection is for hospital staff to wash their hands often.
Richards said healthy people cannot get this disease.
He said doctors put tubes and catheters into patients’ bodies and veins, which allowed an entry point into the body.
In addition, plastic devices had a much higher propensity than human tissue for attracting organisms and allowing them to grow on them.
“Another issue is, South Africa and hospitals have been very good at setting up antimicrobial stewardship programmes monitoring the after-use of antibiotics.”
However, SA was behind in antifungal stewardship – managing medicines used to treat fungi.
Richards said: “While South Africa’s candida auris is resistant to first-line drugs, called azoles, and treated by another kind, called echinocandins, if we keep using these there will eventually be a resistance.
“It is the new superbug.”