Hospital Acquired Infections (HAI): Debilitating Health-care and Treatment Opportunities
The hospital environment is one of the biggest reservoirs for antibiotic-resistant strains of bacterial pathogens, which can range from being multi drug-resistant to superbugs. Patients in the ICU (intensive care unit), those on ventilators or with open wounds & immunocompromised individuals are often exposed to very high densities of these pathogens and can contract diseases like pneumonia, bloodstream infection, and urinary tract infections (UTIs). The global problem of antimicrobial resistance translates most aggressively in a scenario, where every patient inside the ICU is at a risk of acquiring these bacterial infections which do not have any pertinent treatment available. According to the WHO, at any given time, around 1.4 million people across the globe suffer from HAIs. Nosocomial infections (another name of HAIs) occur in 5-10% of hospital admissions worldwide. In India, the infection rate is alarming and is estimated at about 35-40% of all hospital admissions. 60,000 newborns die every year in India due to MDR nosocomial infections. Hospital acquired comorbidities cause great physical, social and economic burden on the patients and their families. The grave problem is the disregard for protocols and casual approach in hospitals along with lack of awareness about correct antibiotic usage among the general public. Therefore, it is more important than ever to prepare ourselves for the post antibiotic era and start developing methods and treatment strategies that can handle multidrug-resistant infections.
COVID-19: An alert to AMR and Ventilator Associated Pneumonia
Globally, the SARS-CoV-2 pandemic is superimposed on the ongoing and steadily rising pandemic of multidrug resistant bacterial infections. Even in a normal scenario, hospitals are the epicentre for (antimicrobial resistance AMR) development. At the time of writing this, there are 40 million COVID-19 cases and counting. Based on our interviews with doctors, we found that one of the largest comorbidities during this pandemic-time is ventilator-associated pneumonia. Diagnosing bacterial pneumonia in ventilated COVID-19 patients is extremely difficult due to similarities in symptoms and so are treated with prophylactic antibiotics to prevent bacterial-infections. Such a strategy is at high risk of selection of multi-drug-resistant bacteria in patients expected to remain under invasive Mechanical Ventilation for a long period. Ventilator Associated Pneumonia (VAP) has been one of the most severe nosocomial infections with ICU mortality rate of 45.6% to 60.9%, reaching 84.3% when VAP is caused by XDR A. baumannii. Some regions like Bangalore report as many as 85% of people infected with the virus die after being placed on ventilation. COVID-19 aggravated the situation of VAP infections in the following ways:
- More than 90% of hospital-associated pneumonia are associated with mechanical ventilation, one of the therapeutics used extensively in COVID-19 patients admitted in the ICU
- Immunomodulatory interventions during COVID-Treatment lead to risk of potentially fatal secondary bacterial respiratory infections and make the tissue more susceptible to MDR bacteria
- Significant increase in AMR selection pressure in COVID-19 units
Ventilator Associated Pneumonia
Under the broad umbrella of hospital acquired infections, the project has a key focus on the problem of ventilator-associated pneumonia (VAP), a condition that claims as many as 250,000 lives in India annually. VAP is the most common nosocomial infection in the ICU and can if not diagnosed at an early stage. It is caused when bacteria-laden secretions from the oral cavity and stomach reach the lungs of a patient who has been on mechanical ventilation (breathing machine) for more than 48 hours. A study in the Indian Journal of Medical Microbiology on VAPs noted that A. baumannii (54% of cases) was the most common pathogen, followed by Pseudomonas aeruginosa (21%). A high rate of MDR (27.3%) was observed with the presence of extended-spectrum beta-lactamases, AmpC and carbapenemase genes.
During our conversations with the field experts, we learnt that carbapenem-resistant A. baumannii (priority 1) is found in most of the healthcare environments and is also a very active human colonizer. The combination of its environmental resilience and its wide range of resistance determinants renders it a successful nosocomial pathogen.
- The burden of health care-associated infection worldwide