One in five patients who stay long likely to be hit; patients with burns at high risk

Francis P Barclay. Bangalore

If you are being wheeled into any of the hospital wards or operation theatres in the city, be prepared to face one of the most lethal bacteria known to man. One in five patients who stays for long at any city hospital has chances of getting infected by the methicillin-resistant staphylococcus aureus (MRSA) bacteria. Burns patients are definitely more at risk. Babies too face the risk of getting meningitis and septicaemia caused by MRSA, said an expert Gayathri Arakere working with Sir Dorabji Tata Research Centre for Tropical Diseases which interacts with hospitals here and helps them in diagnostics. Arakere said about 40% to 50% of staphylococcus aureus strains isolated from the burn and trauma wards of two leading hospitals in Bangalore were found to be methicillin-resistant. In some of the city's hospitals, the prevalence was found to be higher. What causes concern is that Type-3 and 3A SCC MEC cassettes of MRSA are entrenched in hospitals. They show resistance to at least five to six classes of drugs. Public awareness of the bacteria is abysmally low. Most healthcare officials do not want to talk about it lest they be blamed for aiding its spread. All city hospitals have become breeding grounds of these 'cockroaches of the microbial world', said Dr H Srinivasa of the department of microbiology, St John's Medical College and Hospital. Also called staph, the bacteria thrive in hospitals which are old and overcrowded, and where hygiene standards are unsatisfactory. They mainly target ICUs and burns units and patients with chronic ailments and weakened immune systems become easy victims. While a recent study placed southern India in the high risk map on superbugs, a 1996 survey put Bangalore atop Indian metros that are most vulnerable to Staph. "Staph profusion is a harbinger of a larger antibiotic resistance pandemic. There are many such microbes that are developing resistance against antibiotics," said Dr Srinivasa, an expert on pathogens. The percentage of drug-resistant mutants in Staph is at least 30% in city hospitals. In some, the percentage is above 50%, he said.Dr Preeti Galagali, a consultant paediatrician of a city-based hospital, said mutant strains of the bacteria had evolved due to the misuse and overuse of antibiotics. "As doctors over-prescribe and patients abuse antibiotics, the bacteria gain immunity," she said. "A government policy that regulates prescription of drugs is needed. Movement of drugs across the counter too should be controlled," said Dr Savitha Nagaraj of St John's Medical College. Staph usually infects an operated area or open wound. To a patient, a secondary superbug infection means additional ailment, longer stay in hospital and additional costs. Understaffing in hospitals facilitates easy transmission of staph infections within the premises. Besides medical instruments, doctors and nurses too become carriers of Staph. A solution to this problem lies in appointing a hand-hygiene co-ordinator, arranging recorded messages urging people to wash their hands and installing ultra-violet light boxes to check washed hands for missed bacteria. It is alarming that MRSA has developed resistance against stronger drugs like vancomycin. But, as doctors say, it is something that needs more than adqequate attention today.