Bahrain - A growing health threat of superbugs in hospitals and care centres has been outlined by a senior Bahraini microbiologist during an international conference.

As the world focused on tackling the Covid-19 pandemic the menacing bacteria that cannot be treated by regular antibiotics continued and the need to constantly monitor patients remains a priority.

“We were focusing so much on Covid-19 in the last two-and-a-half years and forgot the risk of an evolving epidemic that has continued during the pandemic and will not go away,” said BDF Hospital microbiologist Lieutenant Colonel Dr Manaf Al Qahtani.

Special research carried out across Gulf countries will provide vital information for health professionals. Almost 20 per cent of patients who were studied, tested positive to one of more superbugs – the carbapenem resistance genes (CRGs).

Superbugs are strains of bacteria, viruses, parasites and fungi that are resistant to most of the antibiotics and other medications commonly used to treat the infections they cause. A few examples of superbugs include resistant bacteria that can cause pneumonia, urinary tract infections and skin infections.

Misusing antibiotics, such as taking them when you don’t need them or not finishing all of your medicine, is the single leading factor contributing to this problem, experts say.

CRGS are harboured in ‘gram-negative bacteria which are tougher to tackle because of their harder cell wall. When their cell wall is disturbed, gram-negative bacteria release endotoxins which usually worsen infections.

Lt Col Dr Al Qahtani was speaking at the 32nd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Lisbon, Portugal – the first ever medic from the GCC to be part of the prestigious global event.

“This is actually one of the evolving medical and public health challenges of today,” he said.

His presentation focused on key messages focusing on the GCC data on the subject, which is being published for the first time, highlighting the importance of active surveillance for CRGs both during the pandemic and in a non-pandemic situation, and finally looking at the impact of Covid-19 on the emergence of current and new CRGs.

“As you know, Covid-19 was a public health emergency but at the same time antimicrobial resistance continued to be a medical and public health challenge,” he added. “So we, as researchers, decided for the first time to uncover the base of the iceberg – in fact, to look at the burden on the nation from those admitted to our facility with CRGs.”

Lt Col Dr Al Qahtani co-authored the study carried out on 529 patients in 11 hospitals from across five GCC countries – Bahrain, Kuwait, Oman, Saudi Arabia and UAE.

“The aim of the study was to determine the prevalence of CRGs and risk factors of its colonisation among patients in GCC hospitals,” said Lt Col Dr Al Qahtani.

“We noted that detection of CRGs in our hospitalised patients varied considerably among the 11 participating hospitals, with one type of CRG accounting for a large proportion of positive results.”

The study was carried out using rectal swabs taken from approximately 50 intensive care unit (ICU) patients from each of the participating hospitals between March and November 2019. They tested for the presence CRGs using a commercial polymerase chain reaction test and data on risk factors were collected and analysed.

“Of 529 specimens screened, 138 (26.1 per cent) were positive for one or more CRGs,” added Lt Col Dr Al Qahtani. “The positivity rates among the hospitals ranged from 8pc to 67.3pc.

“Almost 20pc of the positive specimens harboured less than two CRGs. Overall, 31.1pc of patients on antibiotics on admission to the ICU were positive for CRGs compared to 16.5pc not on antibiotics.

“Prior antibiotic exposure, increasing age and a prolonged length of stay in hospital were associated with CRG detection.”

On the future possible scenarios, Lt Col Dr Al Qahtani highlighted the uncertainties amidst the emerging Covid-19 variants.

“The duration of protection against CRGs (by antibiotics), vaccine response in vulnerable population and its efficacy on new variants of concern, all of these are among the uncertainties,” he said.

“Once healthcare and travel revert to full capacity, more antimicrobial resistance should be expected.”

Meanwhile, the study also cited that the high number of resident expatriates, many of who come from regions where CRGs are endemic, may also have contributed to the rates observed.

The scourge of the organisms which harbour these transmissible genes within patients’ bodies (gram-negative bacteria) is an evolving medical and public health challenge, highlighted Lt Col Dr Al Qahtani.

Drug resistance (antimicrobial resistance) is a naturally occurring phenomenon that can be slowed, but not stopped. Over time, germs such as bacteria, viruses, parasites and fungi adapt to the drugs that are designed to kill them and change to ensure their survival. This makes previously standard treatments for some infections less effective, and sometimes ineffective. Researchers continue to evaluate how these germs develop resistance. They also study how to diagnose, treat and prevent antimicrobial resistance.

Certain actions may step up the appearance and spread of antimicrobial-resistant germs, such as:

• Using or misusing antibiotics

• Having poor infection prevention and control practices

• Living or working in unclean conditions

• Mishandling food

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