Last November, Northern Sound reported that the CPE (carbapenemase-producing Enterobacterales) superbug had arrived in Cavan General Hospital. This is a hugely concerning development for our locality!
Some background first. Many of us suffer from bladder, kidney, chest, or skin infections. These are caused by bugs which have been around for billions of years but only since the discovery of penicillin in the 1940s, have we been able to successfully treat them. By virtue of their ability to rapidly multiply and diversify, and because of repeated and sustained exposures to different types of antibiotics, these bugs have figured out ways to resist drugs designed to kill them (‘antibiotic-resistant’) or, to put it another way, to prevent antibiotics from treating our infections. ‘Superbugs’ are ‘resistant’ to a wide range of currently available antibiotic drugs, including those given by drip in the hospital.
Superbugs, like MRSA or CPE, often reside harmlessly on, or in, our bodies but if they emerge to cause bladder, kidney, chest infections etc (i.e. superbug infections!), these infections are significantly more difficult to treat. CPE is considered by far the most concerning as there really are very few, if any, drugs available for treatment. Without many new types of drugs on the horizon, it is the likes of CPE that has left many wondering if we are returning to a pre-antibiotic era, an era where people could commonly die from kidney infections or where most surgeries, including Caesarean sections and joint replacements, cancer chemotherapies, transplantations, and intensive care would not be possible given the risk of subsequent untreatable infections.
In a 2014 UK government-commissioned review, it was predicted that “10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug resistant infections if we do not find proactive solutions now to slow down the rise of drug resistance. “ To put this in context, by 2050, as many as 10 million people could die annually worldwide from antibiotic resistant infections which would be equal to as many deaths from cancer and diabetes combined. A UN General Assembly Meeting was held in 2016 to discuss a health-related issue for only the fourth time in history, the topic being antibiotic resistance. The third time was on the AIDS crisis back in the 1980s! Our own Minister for Health, Simon Harris, declared CPE a national public health emergency in 2017.
Whilst the future would appear bleak, antibiotic resistance is very definitely a problem now. Many Irish families will have an empty chair at the dinner table next Christmas because of it. We already know that CPE itself is contributing to Irish deaths. In a recently published external review of deaths in University Limerick Hospitals in patients known to have had CPE, CPE was thought to have been an associated factor in at least eight. If you have not heard about this problem before now, it is probably because thankfully, either you or some of your family members have not recently been admitted into Hospital.
The antibiotic resistance problem, and the required solution(s), is complex but I’d like to focus here on human antibiotic use given the current ‘flu season that is upon us. It is antibiotic use, misuse and abuse that largely drives antibiotic resistance and causes superbug infections. Antibiotics, unlike any other medication, have an impact beyond the patient they are intended for in that superbugs can spread to other members of the community, including family members. Publicly available data suggests that we consume more antibiotics per head of population in Cavan/Monaghan than in Roscommon, for example, and that the rate of antibiotic use is higher in Cavan General Hospital than in most other Irish hospitals. It is hard to believe we suffer more infections here than elsewhere. Patients generally prefer being prescribed antibiotics (unaware of the potential longterm problems) but it is not their fault. As most human antibiotics are prescribed by GP’s, a lot of the blame for giving many unnecessary antibiotics lies with us. We as GP’s, need to use antibiotics judiciously and where the evidence clearly indicates that the benefit is greater than the risk. They should not be seen as a cure for all infection-related ills or as a ‘just-in-case’ drug. Believe it or not, many patients who visit their GP this season with a ‘chesty cough’, ‘green phlegm’ or a ‘sore throat’ will suffer more long term harm than good from an antibiotic!