(BN) Greek Doctors Battle Hospital Superbug as Crisis Depletes Budget
Sad. Junker has demanded full implementation, assurances future governments won’t change, and singing Wagner while standing on one foot with your eyes closed trying to touch your nose.
Deal or no deal, it’s hard to see how this isn’t spiraling out of control and someone should keep in mind that most of the bailout money, even after PSI goes not to Greece but to foreigners who bought Greek bonds.
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Greek Doctors Battle Hospital Superbug as Crisis Depletes Budget
2012-02-09 22:01:00.0 GMT
By Naomi Kresge and Jason Gale
Feb. 10 (Bloomberg) — Greek doctors are fighting a new
invisible foe every day at their hospitals: a pneumonia-causing
superbug that most existing antibiotics can’t kill.
The culprit is spreading through health centers already
weighed down by a shortage of nurses. The hospital-acquired germ
killed as many as half of people with blood cancers infected at
Laiko General Hospital, a 500-bed facility in central Athens.
The drug-resistant K. pneumoniae bacteria have a genetic
mutation that allows them to evade such powerful drugs as
AstraZeneca Plc’s Merrem and Johnson & Johnson’s Doribax. A 2010
survey found 49 percent of K. pneumoniae samples in Greece
aren’t killed by the antibiotics of last resort, known as
carbapenems, according to the European Antimicrobial Resistance
Surveillance Network. Many doctors have even tried colistin, a
50-year-old drug so potent that it can damage kidneys.
“We’re not used to seeing people die of an untreatable
infection,” said John Rex, vice president for clinical
infection at London-based AstraZeneca, which is developing a new
generation of antibiotics. “That’s like something in a novel of
200 years ago.”
The superbug is one among many challenges facing the home
of the Hippocratic oath, “first do no harm.” The government,
confronting a 14.5 billion-euro ($19.3 billion) bond payment on
March 20, is trying to arrange financing to avert a collapse of
the economy. Partly as a result, the health system is in crisis,
with some life-saving drugs in short supply and hospitals
struggling to pay their bills.
Nurse Ratio
Greece has the lowest nurse-to-patient ratio in Europe and
one of the highest rates of antibiotic use — and abuse — on
the continent, hindering the attack on the infection.
George Daikos, an associate professor of medicine at Laiko
General, won one battle last year in the ward for people with
leukemia and other blood disorders by separating people carrying
the bacteria from uninfected patients and forcing busy nurses to
wash their hands more often. Fighting the infection in the rest
of the hospital, where one nurse cares for as many as 20
patients, casts Daikos as Sisyphus, the mythological king doomed
to roll a boulder up hill, only to watch it tumble down again,
over and over for eternity.
“We know what to do, but if you don’t have the personnel,
you can’t do it,” Daikos said in an interview in his office,
deep in a side wing of the sprawling hospital. “If you don’t
have enough nurses, how can I assign a dedicated nurse to
carriers?”
Spreading Superbug
The superbug, dubbed KPC, first appeared in Greece in 2007
after spreading through the U.S. and then Israel. By 2010,
Austria, Cyprus, Hungary and Italy were also experiencing an
increase in cases, the European Centre for Disease Prevention
and Control said in a surveillance report in December.
In the worst outbreaks, as many as half of the people who
develop a blood infection due to KPC are killed, doctors in
Toronto said in a review article in the journal of the Canadian
Medical Association last year.
While Greece is striving to curb KPC, the country faces
fewer problems with multi-drug resistant, so-called Gram-
positive bacteria such as methicillin-resistant Staphylococcus
aureus, the superbug better known as MRSA, than do other
nations, said Spyros Pournaras, an associate professor of
medical microbiology at the University Hospital of Larissa.
Pournaras helped write the Oxford Journals article that
identified KPC’s first sweep of a Greek hospital in 2007.
‘Not a Threat’
“We have problems,” he said in an interview in Athens.
“But let’s not generalize that we’re a threat for Europe.”
Greece also doesn’t have so-called Gram-negative bacteria with
gene mutations known as NDM, IMP and OXA-48, which are common
elsewhere, Pournaras said.
Even so, Greece has a bigger problem than do other
countries because its doctors over-prescribed antibiotics, said
George Dimopoulos, an associate professor of intensive care
medicine at Attikon University Hospital in Athens. Greeks used
more antibiotics than residents of any other European country,
according to a 2009 survey by the European Surveillance of
Antimicrobial Consumption. Antibiotic use outside hospitals was
more than twice the median.
Another issue is the lack of nurses, Dimopoulos said. For
example, an overworked nurse might change a catheter or a wound
dressing without washing her hands, he said — a prime
opportunity for bacteria to hop from one patient to another.
He held up his hands. “This is number one,” Dimopoulos
said, for transmission of the bacteria. “This and the
stethoscope.”
Blood Poisoning
Once a patient is infected, the bacteria can attack almost
anywhere in the body, damaging the lungs and urinary tract or
poisoning the blood. Patients whose immune systems are weakened
by chemotherapy or who are already critically ill are the most
vulnerable, Dimopoulos said. The bugs can kill via a lung
infection, with patients coughing up a bloody mucus, or in the
most severe cases by causing sepsis and shutting down organs one
by one.
“The bacteria are more clever than the human beings,”
Dimopoulos said in an interview in his office in December, a few
steps from where three KPC-infected patients were being isolated
from other people at the hospital.
A team from the Hellenic Center for Disease Control and
Prevention is organizing hospital visits to push clinics to
separate infected and uninfected patients and implement hygiene
measures like hand-washing, the Greek health surveillance
agency, which goes by the acronym Keelpno, said in an e-mailed
response to questions. The program doesn’t include funding for
hospitals to hire more nurses or other personnel, the agency
said.
25,000 Deaths
Keelpno didn’t provide specific numbers on resistance.
Multi-drug resistant infections are more common in very sick
patients in intensive care than in regular hospital wards, the
agency said. About 25,000 people die each year across Europe
from antibiotic-resistant infections, the agency said.
Greece has little extra money to fight the germ or to buy
expensive new antibiotics. Greek hospitals ran up so many unpaid
bills from 2007 to 2009 that the government agreed in 2010 to
issue more than 5 billion euros of non-interest paying bonds to
hospital suppliers to cover the debts.
People hospitalized or treated in Greece and then
transferred to other European countries pose a risk for
introducing resistant germs, the ECDC said in a November 2011
report. Studies of cross-border transmission show patients
arriving in a European country with a carbapenem-resistant
infection are almost four times more likely to have just been in
Greece than any anywhere else.
Health-Care Bugs
“These are bacteria that are not commonly found in the
community; these are health-care bugs,” said Alex Kallen, a
medical officer for the U.S. Centers for Disease Control and
Prevention, in a telephone interview. “For people admitted to
the hospital, this is a huge issue. They tend to circulate in
hospitals and long-term care facilities and places like that.
The problem you have is that once you get an infection with one
of these, the mortality rates are much higher, and you’re also
severely limiting your treatment options.”
The more infected patients are housed together and the
fewer nurses there are to treat them, the more easily such bugs
can spread, Kallen said.
“If you’re on a ward with five other patients who have
this, your risk is higher for developing infection regardless of
how healthy you are,” he said.
Double-Wrapped Germs
KPC is part of the so-called Gram-negative group of
bacteria, which also includes E. coli and Pseudomonas. Companies
developing new antibiotics so far have focused more on Gram-
positive bacteria such as MRSA.
Gram-negative bugs are more sophisticated organisms, easily
able to acquire and pass resistance between each other,
AstraZeneca’s Rex said. They are also tougher, he said.
“Have you ever gotten a Christmas present where you get a
wrapped box and inside there’s another wrapped box?” he said.
“The Gram-negatives are like that. They’re double-wrapped,
whereas the Gram-positives are only single-wrapped. Each one of
those wraps is a layer of defense for the organism.”
AstraZeneca is among the drugmakers taking the fight to
Gram-negatives. Working with Forest Laboratories Inc. of New
York, the company is in the final stage of clinical trials in an
antibiotic called CAZ-AVI. Greece is among the places where it’s
being tested in humans. AstraZeneca aims to have approval to
sell the drug by 2014, Rex said.
Glaxo, Cubist
Fellow U.K. drugmaker GlaxoSmithKline Plc said it’s also
testing a candidate in humans, including in Greece, though it’s
not as far along. Cubist Pharmaceuticals Inc., a U.S.
biotechnology company, is testing antibiotics that may work
against KPCs in the lab, though not yet in humans, Chief
Scientific Officer Steven Gilman said in a telephone interview.
A new crop of drugs “could buy us another decade” of
effective treatment, said Karen Bush, an adjunct professor of
biology at Indiana University in Bloomington and former head of
antimicrobial drug discovery research at Johnson & Johnson.
Bush’s lab analyzes changes in bacteria that allow them to
resist drug treatment. “I’m hoping it will be more than that.”
For Related News and Information:
Top Stories: TOP <GO>
Top health stories: HTOP <GO>
Top Greek stories: TOP GR <GO>
Bloomberg drugs database: BDRG <GO>
–With assistance from Tom Stoukas in Athens and Kristen Hallam
in London. Editors: Kristen Hallam, Rick Schine
To contact the reporters on this story:
Naomi Kresge in Berlin at +49-30-70010-6233 or
nkresge@bloomberg.net;
Jason Gale in Singapore at +65-6212-1579 or
j.gale@bloomberg.net
To contact the editor responsible for this story:
Phil Serafino at +33-1-5530-6277 or
pserafino@bloomberg.net