TV hírek szerint Magyarországon többen halnak meg kórházi fertőzésben, mint az utakon. Hogyan is? Kórházba azért megyünk, hogy meggyógyuljunk, nem azért, hogy felcsípjünk egy olyan fertőzést, amibe belehalunk, de miért?
A penicillin (véletlenszerű) felfedezése forradalmasította a gyógyászatot. A korábbi halálos fertőző betegségeket a penicillin segítségével napok alatt sikerült legyőzni. Ez azonban a múlté, a szuper baktériumok megjelenése óta a helyzet drámaian megváltozott.
Mi az igazság az MRSA szuper baktériumokkal kapcsolatban?
A Daily Mail-ban megjelent ismertetés szerkesztett fordítása.
Becslések szerint (Angliában) évente mintegy 5000 ember hal meg olyan fertőzés következtében, amit egy kórházban kapott. Ezen fertőzések nagy részét MRSA baktérium okozza (Meticillin-re Rezisztens Sztafilókokkusz Aureusz). Ez a kórházakban található leggyakoribb baktérium. Erre a baktériumra az jellemző, hogy a szintetikus penicillinre, a meticillinre nem érzékeny.
Az 1940-es években a sztafilókokkusz aureusz baktériumok 95 százalékát meg lehetett állítani, ami mára 10 százalékra csökkent, aminek két fő oka van………
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What is the truth about the MRSA superbug?
By RORY CLEMENTS, Daily Mail
An estimated 5,000 people die every year due to infections picked up in hospital.
Many of these deaths are due to MRSA – Methicillin-Resistant Staphylococcus Aureus – the most common ‘superbug’ found in hospitals.
What singles MRSA out from other bacteria is that it cannot be killed by the standard antibiotic methicillin (a synthetic form of penicillin).
In the 1940s, 95 per cent of staphylococcus aureus could be controlled by penicillin, but this is now down to 10 per cent. There are two main theories why.
One is that the bacterium mutated as it became accustomed to antibiotic drugs. Another is that certain strains of staphylococcus aureus had always been resistant to the drugs, and have prospered in the way that stronger species always do as part of the evolutionary process.
Whatever the cause of the resistance, the bacterium thrives in dirty environments, and falling hygiene standards in hospitals have helped its progress. In the past decade, deaths from MRSA have tripled.
Why does it thrive in hospitals?
One in three people carries staphylococcus aureus (which may or may not be of the methicillin-resistant strains) as a harmless organism on moist parts of the body such as hands, noses and armpits.
In the vast majority of cases it does no harm, because it has not got into the bloodstream via a break in the skin, and the immune system is strong enough to repel infection.
The bacterium is, however, dangerous to anyone who is ill or who has had an operation – making hospital patients particularly vulnerable.
The most common way the infection is spread in hospitals is by a member of the medical staff touching a patient who has the bacteria on their skin, then – without ensuring their hands are absolutely clean – moving on to another patient and passing on the bug into a wound.
The bacteria can also survive away from the body – in dust, in unwashed bedding and on medical equipment.
For patients, the most dangerous time is during surgery when there are open wounds for the bacteria to enter the bloodstream. Ironically, the very advances in medical science that keep so many people alive can also be a danger. Drips, monitors, ventilators and dialysis equipment all provide avenues for bacteria to get into the bloodstream.
Wherever the bugs attack and are not beaten off by the body’s immune system, they cause infection. This can be in the form of boils, bone joint infections or septicaemia (causing a raging, often deadly fever).
Who is at risk?
The frail, the sick, those having surgery and those with lowered immunity after undergoing treatments such as chemotherapy or anti-rejection drugs after transplant are most vulnerable.
The bug can attack patients who go into hospital for surgery but are otherwise healthy.
MRSA figures are difficult to come by because so many people carry it harmlessly. Also, the people who die are generally very ill from some other cause – so it is difficult to say whether they have been killed by the MRSA.
There is no doubt the problem is getting worse. Public Health Laboratory Service figures show that 4,767 patients in England and Wales suffered an MRSA bloodstream infection in 2001. Figures are expected to have risen to over 7,000 last year.
Research funded by the European Commission names Britain as the worst country in Europe for MRSA infections. The proportion of MRSA septicaemias is 15 times greater than in the safest countries – Holland, Denmark, Sweden and Iceland. Hospitals in London and the South-East are reported to have the greatest incidence of the bug in the country.
In 2000, the National Audit Office estimated that 100,000 infections a year are acquired in British hospitals, affecting 9 per cent of patients at any time. The death toll from such infections (not just MRSA) is 5,000 a year.
How can it be prevented?
The best prevention is good hygiene – cleaning your hands properly using an alcohol-based gel. Doctors or nurses squeeze the gel on to their hands and rub them together for 15 seconds until the hands are dry. No towel or basin is needed.
Hospital hygiene itself is vital. Floors should be cleaned with dust-attracting mops or vacuum cleaners, and bedding should be washed at high temperatures and pressed with a hot iron – both effective ways of killing bacteria.
In a survey of 56 NHS Trusts last year, hospital bosses admitted that equipment is routinely left uncleaned and that doctors fail to wash their hands.
Dr David Livermore of the Public Health Laboratory Service believes it is wise to have separate wards for ‘clean’ and ‘dirty’ surgery, so lessening the risk of spreading the bug.
Dirty surgery is that involving the gut, where a lot of bacteria, including MRSA, may lurk. If the bacteria can move from the gut to the bloodstream – perhaps via a piece of equipment – an infection may occur.
Clean surgery is something like orthopaedic or cardiac, where the risk of infection ought to be much lower.
In April 2001, the Government ordered all hospitals to report serious MRSA infections – where the infection gets into the bloodstream. It also issued new guidelines on hygiene, isolating infected patients and disposing of needles.
In 2000, a clean hospitals programme was launched, with £31 million allocated to NHS trusts.
What are the treatments?
The main antibiotic for treating MRSA patients has been vancomycin, but there have been reports of resistance and it can only be given intravenously.
New antibiotics are being developed to attack resistant bacteria. These include the newly licensed drug linezolid – the generic name for Zyvox, which can be given orally.
This drug allows patients to leave hospital earlier and be treated at home, reducing the risk of cross-infection in hospital. However, a case of resistance to this drug was reported at University College Hospital in London last month.
Another new antibiotic is Synercid, which is 71 per cent effective as an emergency treatment but cannot be given orally.
Clinical trials have also been carried out on a vaccine called StaphVAX. American and French researchers who carried out trials on 1,900 kidney patients – who have low immunity – reported the vaccine 57 per cent effective.
Scientists are working on an improved version, which should provide 80-90 per cent protection.
Can I protect myself?
If you are going for an operation, ask your surgeon what the hospital’s MRSA rate is and what is being done to control it.
Use your eyes. Is the lavatory clean? How are the floors, the curtains and the bedding?