Lethal bacteria on the rise in SA

South Africa is facing a silent epidemic in hospital wards of potentially lethal bacteria that are resistant to all known drugs.

The National Institute of Communicable Diseases this week said its laboratory had confirmed 63 cases of totally-antibiotic-resistant superbugs collectively known as Carbapenem-resistant Enterobacteriaceae (CREs) since they first appeared in South Africa less than two years ago.

One private laboratory, Ampath, has detected 96 CRE cases since February 2011.

The bug has been found in private and public hospitals around the country. Able to survive in the human stomach and on hospital surfaces, it turns treatable infections into life-threatening cases by transferring its own drug resistance. It can be passed from patient to patient in hospitals.

The bug has yet to be declared a notifiable disease and hospitals do not have to report cases, so the full extent of the problem is hidden.

Many hospitals already face an infection-control crisis. Some kinds of bacteria are so common that medical experts say they are here to stay.

Springbok rugby player Schalk Burger has been diagnosed with bacterial meningitis following an operation to reduce pressure on a nerve. It is not yet clear where he picked up the infection.

CREs are just one of several new multidrug-resistant superbugs that have developed mostly because of the incorrect use of antibiotics.

Now the institute - a state entity - wants the government to declare CREs a notifiable disease, which will force hospitals to report every case.

"This number [63] does not represent the national prevalence of CREs, but it is a warning of emerging resistance that threatens to produce an epidemic of CREs," the state laboratory said in its latest communicable diseases communique.

The institute's principal pathologist, Olga Perovic, said: "There is a problem. We need to face it. That is what we are trying to do."

The government is finalising a report into a recent CRE outbreak on the East Rand of a bug called NDM-1. Other superbugs reported in the country include OXA, KPC, VIM and GES.

Drug-resistant bugs are a global problem. The UK's most senior medical adviser has called for them to be classified on the national risk register for civil emergencies on a par with terrorist attacks.

Adrian Brink, head of microbiology at Ampath, said: "It is an emerging threat; there is no doubt about it. What we are seeing is a spread of drug-resistant bugs throughout the country."

Private healthcare group Life Healthcare declined to divulge its cases. Spokesman Julie MacLiam said hospital screening had detected "one or two new cases every month" on the East Rand so far this year.

"We take a proactive ultra-cautious approach to all positive results and isolate those patients until discharge," MacLiam said.

Figures published by the South African Society for Clinical Microbiology show that drug-resistant bugs are spreading.

The figures, which do not specify CRE superbug infections, are based on tests of serious infections by several laboratories. They found:

More than 400 cases of P.aeruginosabacteria from January to June 2012. The bug attacks damaged tissue and infects patients with low immunity; 12% of 44 cases in Cape Town were resistant last-resort antibiotics;

Only two of more than 800 cases of Klebsiella pneumonia responded to Ampicillin, the most common antibiotic. In Johannesburg, more than 60% of these cases were resistant to all but one class of antibiotic; and

In Durban, 27% of 217 cases of E.coli were resistant to most antibiotics.

Professor Mark Nicol, chairman of the South African Society for Clinical Microbiology, said the country lacked the surveillance needed to get an accurate picture of superbug infections.

He said many multidrug-resistant bacteria were now endemic to South African hospitals and if the same thing happened with totally drug-resistant superbugs, the healthcare system would face a potential disaster.

"It is very difficult to eradicate these drug-resistant organisms once they have a foothold, because their primary reservoir is in people's guts," Nicol said.

Guy Richards, head of the intensive care unit at Charlotte Maxeke Johannesburg Academic Hospital, said drug-resistant bugs often arrived with foreign visitors. "Major sources are Angola and Nigeria, where minimal antimicrobial monitoring is done," he said.