Tuesday 9 May 2017

Nightmare superbug

You will have heard of MRSA [multibloboprev], it's the bacterial infection that killed your beloved Auntie May when she went to hospital for that hip replacement. You may be hazy about the long words represented by the acronym. I believe even in France 'MRSA' is used rather than SARM Staphylococcus aureus résistant à la méticilline. When I worked in St Vincent's University Hospital 10+ years ago, they were getting a new case of MRSA diagnosed by the path lab every day. The hospital has a little over 500 beds [and a helluva a lot of trolleys for the overflow].

When I set off across the Irish sea last week there was a whippy Nor'Easter raising waves, so I left the car deck with a sleeping bag, a rug and a pillow case in which to stuff my fleecy. I found a quiet corner - not under one of the many large TVs; away from the play-area; away from the smell of frying fish [it was Friday, near Catholic Ireland] - and got horizontal for the crossing. Ten minutes later a handful of loud American voices settled in the next bay and 5 minutes later another Yankee-voice piped up "Aha, I've found my fellow nurses, do you mind if we talk shop?". It transpired from the transcript (my eyes were firmly closed) that an enterprising tour-company had filled a coach with nurses and paramedics, active and retired, from all over North Carolina and as far down as Greenville S.C. They were on a whistle-stop "If it's Tuesday, it must be Kilkenny" of Ireland and the cherry on the cake was a night in Cardiff [it's the castle] before heading on to Heathrow and home. Would they stop talking? No, they would not!

The shop-talker quickly brought the chat round directly to "Do you have CRE in your hospital?" to which everyone answered in the affirmative. Not having much truck with hospitals since Auntie May succumbed, I had to look it up: CRE is Carbapenem-resistant Enterobacteriaceae  aka carbapenemase-producing Enterobacteriaceae (CPE) because the key enzyme carbapenemase is what what makes food out of the antibiotics called carbapenems. They are the drugs of last resort for nosocomial hospital acquired infections. Enterobacteriaceae  are E.coli and their many and varied relatives.  Carbapenems are drugs of last-resort because these bacteria are already resistant to penicillins and cephalosporins. All three classes of drug contain a beta-lactam ring which looks sufficiently like components of the bacterial cell wall, that they get incorporated by the wall-building machinery like faulty bricks. This compromises the cell-wall integrity and the bacteria die.  But they don't die if they can treat the antibiotics like so many calories.

Unless you are having this Blob read to you in a hospital bed as you toss your fevered brow about, you have nothing to fear from CRE. Our immune system is quite capable of knocking the stuffing out of rogue Enterobacteriaceae and Staph. aureus.  To the nearest whole number 100% of cases of CRE are acquired in hospitals because the management has allowed sketchy cleaning practice to develop: the medicine cabinets are not blitzed often enough, the hand-washing is irregular, the staff spend too much of their shift filling in forms and reports. These hospitals will have all the million-dollar kit: the CAT-scans and MRI instruments, colonoscopy cameras and half-million dollar managers but the grunts on the wards are having to do too much on too little pay to care.  It must seem ironic when your Auntie May [mine has gone to her rest] is shipped 100km to a big teaching hospital where all the experts and equipment are, by modern medical philosophy, corralled (but which is too far from home to allow easy visiting)  and then dies in a bloody flux from MRSA or CRE.  When your immune system is compromised because of whatever brought you to hospital, then you are much more likely to get one of these antibiotic-resistant infections. If every surface, every bed-frame, every hand and every food tray is cleaned to within an inch of its life then there are no bacteria to get above their station in life. Cleaning is hard work, desperately unsexy, and cannot be carried out if you are wearing a tie and have a stethoscope draped round your neck to prove that you've done 4 years in Med School.  Basic hygiene and cleanliness, especially clean water, have saved more lives this century than all the CAT scans put together.

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