KEY POINTS:
The emergence in hospitals of mutant bacteria resistant to all known antibiotics is inevitable, an Auckland immunologist says.
But the battle to develop new antibiotics is still being won, adds Professor John Fraser, of Auckland University.
He said yesterday that Auckland City Hospital could not avoid disease outbreaks such as vancomycin-resistant enterococci (VRE); the hygiene precautions would be so extreme that it could no longer function as a hospital.
The hospital completed a massive, eight-day clean-up on Monday to kill any VRE on surfaces or in beds after a patient was found to be infected with the potentially fatal disease.
More than 1000 patients have been tested for VRE in the past two months. Including the first case, four patients were found to have the illness and 38 have been diagnosed as carriers. The testing of new inpatients will continue for up to four months and 12 carriers remained in isolation yesterday.
Enterococcus is a common bowel bacterium which generally causes illness only when it enters the bloodstream, for example through a wound. It can cause serious illness and death in those with an already weakened immune system. A hospital spokeswoman said yesterday that patient test results showed the National Women's Health service was not affected by VRE. Starship children's hospital results were due by tomorrow.
Professor Fraser said a normal enterococcus could switch from being sensitive to vancomycin, an antibiotic, to being resistant just by contact with a resistant strain.
"Of course hospitals are a great meeting place for bacteria and this is why outbreaks of drug-resistant organisms happen there."
He said vancomycin was traditionally the antibiotic of last resort for treating another superbug, methicillin-resistant staphylococcus aureus (MRSA). However, several instances of vancomycin-resistant staphylococcus aureus (VRSA) had been reported in individual patients from Japan, the US and Europe since 1996. VRSA infections remained extremely rare but were very difficult to treat.
Unnecessary use of antibiotics could render them useless against newly emerging bacteria, but the pharmaceutical industry's development of new antibiotics was "just managing to keep ahead" of the resistant strains, Professor Fraser said. However, unlike the broad spectrum antibiotics originally developed, the new ones were targeted against just a narrow range of bacteria, making them more complex to use because doctors treating seriously unwell patients would have to wait for test results to choose which medicine to give.
