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Thursday, Sept. 9, 2010

EDITORIAL

Bacterial assault on hospitals

Fifty-three patients at Teikyo University Hospital in Tokyo's Itabashi Ward have been infected with the multidrug-resistant Acinetobacter bacterium since August last year. Thirty-one of them died later of various causes, and nine of those deaths are believed to be directly attributable to the superbug. The nine were 53 to 89 years old.

It is regrettable that the hospital failed to take quick and effective measures to contain the spread of a hospital-acquired, antibiotic-resistant bacterium and failed to immediately report the in-hospital infections to authorities. These cases should sound the alarm bell for the nation's hospitals, while warning the public that hospitals are not necessarily safe places but are full of potential dangers, including hospital-acquired (nosocomial) infection. Hospitals must vigilantly guard against such infections.

A better known antibiotic-resistant bacterium is the methicillin-resistant Staphylococcus aureus (MRSA). According to a panel on infection diseases of Iryo Anzen Zenkoku Kodo (National Action for Medical Safety), a network of some 600 hospitals to promote medical safety at hospitals, MRSA is directly responsible for the deaths of an estimated 4,000 people every year through nosocomial infections.

The outbreak at Teikyo University Hospital shows that Acinetobacter is a new addition to the list of antibiotic-resistant bacteria that cause in-hospital infections, which already includes MRSA, Pseudomonas aeruginosa and Serratia marcescens. Acinetobacter widely exists in such places as soil, water and human skin. It kills by causing pneumonia or sepsis in patients whose physical strength or immunity has been weakened.

To prevent hospital-acquired infections by antibiotic-resistant bacteria, hospitals must use antibiotics with care; diligently disinfect toilets, human waste storage areas, intravenous drip devices and artificial respirators; and have hospital workers and patients wash their hands adequately and frequently.

In Europe and North America, multidrug-resistant Acinetobacter was identified in the 1990s. At Fukuoka Hospital University, 23 patients were infected by the bacterium from October 2008 to January 2009. Of the four who died, the deaths of two were directly linked to the bacterium. Stronger strains of multidrug-resistant Acinetobacter were detected among patients at the Funabashi Municipal Medical Center in 2009 and at Aichi Medical University Hospital in 2010. The patients, who had been transferred from hospitals abroad, were quickly isolated, and the infection of other in-patients was prevented. The experiences at the two institutions show that hospitals can prevent nosocomial infections by following basic hygienic procedures.

Teikyo University Hospital initiated steps to prevent in-hospital infections following Golden Week in May after multidrug-resistant Acinetobacter had been detected among about 10 patients in the internal medicine ward. A study showed that the first case of the infection had occurred in August 2009 and that a female patient died in October 2009 and a male patient died in January 2010. But this information was not conveyed to a hospital section in charge of preventing nosocomial infections.

Eventually patients on eight floors of the 19-story and two-basement hospital were found to have been infected with the bacterium. The hospital has not yet been able to control the outbreak of nosocomial infection. As of Sept. 1, nine patients were infected with the bacterium. It is clear that doctors, at least in the internal medicine ward, were not sufficiently aware of the danger of hospital-acquired infections.

In July, the hospital set up an investigation panel that includes outside people. But it did not report the establishment of the panel to the local public health center. On Aug. 4, the central and Tokyo metropolitan government carried out a regular inspection of the hospital, but the hospital did not tell them about the in-hospital infections. Not until Sept. 2 did it report the infections to the health ministry, the metropolitan government and the Itabashi Ward office. It was also found that three patients at the hospital had been infected with another antibiotic-resistant bacterium — the multidrug-resistant Pseudomonas aeruginosa — and that one of them had died. The hospital bears a heavy responsibility. If it had acted properly, it could have saved the lives of patients.

Multidrug-resistant Acinetobacter appears to have spread. In Aichi Prefecture, 24 in-patients at Fujita Health University Hospital have been infected with the bacterium since February and seven others at another hospital since October 2009.

On Monday, it was reported that a new type of superbug, a colon bacillus with the NDM-1 gene, which is resistant to most antibiotics, was found in one patient at Dokkyo University Hospital in Mibu, Tochigi Prefecture. The patient, who had returned from India in May 2009, was successfully treated.

All hospitals should heighten their awareness of the danger of nosocomial infections by antibiotic-resistant bacteria and strengthen measures to prevent them. The National Institute of Infectious Disease and experts must properly advise them.



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