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The bacterium Klebsiella pneumoniae New Delhi, resistant to all antibiotics, was found in several hundred patients of Warsaw hospitals. – The number of infections is growing rapidly and is difficult to stop. This is one of the most dangerous epidemiological situations in Europe. The invention of a cure for this bacterium will probably take several years, says Dr. Tomasz Ozorowski, a microbiologist, expert of the National Antibiotic Protection Program.
Agnieszka Sztyler-Turovsky: Doctor, is Poland threatened by an epidemic?
Dr. Tomasz Ozorowski: Yes. Whether or not we stop it depends on two factors: the effects of the team set up at the Provincial Sanitary and Epidemiological Station in Warsaw and, above all, the mobilization of capital hospitals to implement the recommendations of the Ministry of Health, which, unfortunately, have not been followed so far. Klebsiella is common in society, but there is concern about the resistance to all antibiotics in New Delhi strains. The situation is very difficult because New Delhi is easy to transfer between people.
How the infection occurs. Can a handshake be dangerous?
Infection in New Delhi, or Klebsiella pneumoniae NDM, spreads in two stages: the first is the transmission of the microorganism between patients, most often by the hands of hospital staff, which are not cleaned or disinfected. In most cases, the transfer of the microorganism results only in the so-called carrier, i.e. the bacterium remains in the digestive tract without causing infection. The second stage is the formation of an invasive infection, when the patient has a gate through which the infection can penetrate into sterile areas of our body. It may be tissue damage after surgery, or a catheter inserted into the bladder or a central vascular line (e.g. the so-called port through which, for example, oncological patients are administered “chemistry” – ed.)
Can the bacteria live, for example, on a stethoscope or on cell phones, and be transferred to the patient from there? Can a nurse move her, who touches the handle with a glove and does not replace it with a new one before she touches the patient?
Yes. The stethoscope should be decontaminated after contact with the patient. Doctors and nurses should limit the carrying of items in their pockets that are not essential to performing procedures and examining patients. This also applies to mobile phones that should be sanitized regularly.
If someone is infected with a superbug in a hospital, but doesn’t know it, it infects the family after leaving the hospital?
No, the bacterium is dangerous for patients with the aforementioned gates of infection, for healthy household members, including children, it should not pose a threat.
What if your child falls over while riding a bike and comes home with a broken knee? If the mother is infected and she is dressing the wound, can she infect her daughter or son?
If the mother follows the basic hygiene rules, which is to wash her hands before applying the dressing, it will not infect the baby. The same applies to all infected who have been discharged from the hospital. If they follow the rules of the game, i.e. wash their hands, the household members need not be afraid. Infection with this bacterium is associated with invasive hospital procedures.
And if one of the household members is bedridden, e.g. terminally ill, and a nurse visits him to change the catheter or give injections, is there a risk of infection?
Yes and no. If the nurse leaves the hospital and goes directly to the sick person, and does not wash their hands and disinfect the items beforehand, they may infect the sick person.
And if someone’s infection with a bacterium leads to, for example, pneumonia, maybe through coughing and droplets infect others?
No, infection is not transmitted by airborne droplets.
Should everyone who have been hospitalized in Warsaw hospitals in recent months be screened? If so, where?
They don’t have to report anywhere. The tests are not performed in people discharged from hospitals. However, screening tests should be performed on patients who are currently admitted to the hospital and who report in the interview that they were treated in hospitals in Warsaw during the last year.
Such studies were theoretically performed after New Delhi infections were discovered for the first time in Poznań and Warsaw 2-3 years ago. Why do you think they did not bring any effect?
They were not made as they should be. Perhaps too little. This is definitely one of the reasons the bacteria spreads rapidly. Last year, infections caused by the superbug Klebsiella pneumoniae type ND were detected in most hospitals in Warsaw. In Poznań, it was possible to stop them. In Warsaw, at the end of the year, as many as 12 outbreaks were detected in 19 hospitals, and from January to March this year, another six were detected in six hospitals. This is a great failure of the Warsaw hospital infection control systems.
Certainly there were lapses. What kind?
Actions that should be performed were certainly not implemented. And guidelines for hospitals were developed by the Ministry of Health for hospitals as early as 2012.
What are these recommendations?
First: testing patients for carrier status. This has been neglected. And these screening tests are necessary because very often the infected have no symptoms.
What is this examination about?
A rectal swab is taken because the bacteria lives in the digestive system.
What about patients who, for example, have been diagnosed with an infection today?
If they are in hospitals, they should be isolated immediately. Absolutely.
But how? Hospitals have a shortage of free beds, and it happens that the sick lie in the corridors. In Warsaw, patients in several or maybe a dozen or so facilities are already infected. Even an infectious diseases hospital cannot accommodate them all – there are not so many isolation rooms. This is a stalemate!
Yes. The situation is very dire. In addition, even if an infectious diseases hospital had enough isolation cells, the transfer of these patients is unrealistic. Usually they were infected e.g. in cardiology and nephrology departments and require specialist treatment. The Infectious Disease Hospital won’t give them that. It seems to me that some Warsaw hospitals are in such a difficult epidemiological situation that they should create, although during this most difficult period, special units for NDM patients.
Can infected people in one ward be jointly isolated from the rest of the sick and, for example, lying in several people in the same room?
Yes. This is called cohortation – placing several patients with the same infection in one room. Hospitals in which New Delhi cases have been detected must organize such isolation facilities on their premises. All you need is a room with its own bathroom, separated from the rest of the ward.
What awaits those who are already infected if there is no cure for the bacteria?
I would like to emphasize strongly that the bacterium Klebsiella pneumoniae NDM is not more virulent than other common bacteria, but is resistant to all antibiotics. This means that in the majority of patients who find it in the form of only the so-called being a carrier, it will never cause symptomatic infection. However, when it reaches it, e.g. in the form of cystitis or pneumonia, we can only count on the patient’s immune system, because we cannot use an effective antibiotic.
So they will be sick for the rest of their lives? What do you think when an effective antibiotic in New Dehli can be found?
A cure for this bacterium won’t come soon. I think it takes at least a few years for that.
Patients from Warsaw are sent by hospitals for tests to centers in other cities. They also go there on their own if they find out that the waiting time for an examination is shorter there. What if hospitals fail to get the situation under control? What’s the worst-case scenario? Will all of Poland fall ill?
If hospitals fail to get the situation under control, the bacteria could spread almost to the whole of society in the coming years. This has already happened in Pakistan and India. Unfortunately, such a scenario may apply to Poland.
Dr. Tomasz Ozorowski is a microbiologist, expert of the National Antibiotic Protection Program.
The Provincial Sanitary and Epidemiological Station, to which we asked for the current list of hospitals with outbreaks, sent us to the County Sanitary and Epidemiological Station. Here we found out that the current list will be available… after the long weekend.
What is New Delhi?