ABU DHABI // High levels of a deadly superbug that targets the vulnerable and seriously ill, and is extremely resistant to antibiotics, have been found in public hospitals in the emirate. Research by the United Arab Emirates University found that, in every hospital studied, Acinetobacter baumannii was present and resistant to antibiotics at a rate "very high by all international comparison". The study found more than 95 per cent of isolated outbreak samples were resistant to antibiotics, compared with only six of 122 isolated samples in a 2002 American study of the superbug.
A. baumannii has been linked to severely injured soldiers, particularly in Iraq, raising its public profile and earning the nickname "Iraqibacter". It causes pneumonia and serious blood and wound infections, and is especially dangerous for burns victims and anyone with a weakened immune system, chronic lung disease or diabetes. The Health Authority-Abu Dhabi (HAAD) told The National it has plans to set up an antibiotic resistance surveillance system across the emirate. Dr Jens Thomsen, of the public health and research department at HAAD, said information about the local situation was still limited and therefore the risk of acquiring an infection is not known.
"Surveillance of antibiotic resistance ? is important," he said, "because it allows the early detection of single cases and outbreaks, to detect and analyse trends and take counter measures to prevent and control further spread." Doctors said hospitals should adopt tighter infection control measures to prevent fatalities, and urged legislators to tighten controls on antibiotic use. Dr Rayhan Hashmey, chairman of the infection control committee at Tawam Hospital, said A. baumannii was probably endemic in every intensive care unit in the country. "You can try to control it but it is very difficult to eradicate as it exists at every level."
"Some hospitals will be more effective than others at managing it. Healthy people will be fine, but the danger comes when they carry it to the sickest of the patients." The author of the study, Noura al Munthari, collected 113 samples of the bacterium from patients in Sheikh Khalifa Medical City, Mafraq, Tawam, Al Rahba and Al Ain Hospitals, over six months in 2008. She found that antibiotic resistance was "common" and "particularly high" in some cases.
She concluded that there were several separate outbreaks that may have spread between hospitals. She recommended establishing a "centrally organised antibiotic surveillance system". Professor Tibor Pal, consultant clinical microbiologist at UAEU, agreed that monitoring and surveillance was essential. "It is present here, that's the experience in every hospital, we just don't know the real extent or connections between hospitals," he said.
Because the bacterium can be found naturally in soil and water, doctors say it is impossible to establish what has caused it to spread so much in the UAE. Without a central surveillance system, it is impossible for health authorities to provide accurate and comparable figures on the numbers of hospital-acquired infections caused by superbugs, including A. baumannii. The Centres for Disease Control and Prevention in the US estimate there are around 1.7 million hospital-acquired infections, from all types of bacteria. A 2002 study cited by the Centre showed that more than a million of these affect adults and children outside intensive care units, and just over 400,000 inside the units.
Dr Mohamed Hamed, head of infection control at the Lifeline Hospital in Abu Dhabi, compiles monthly reports on drug-resistant bugs found in the hospital, in accordance with international best practice. "Not all hospitals will do this," he said. "They often don't know the statistics or they don't want to give out the data, no one likes to compare. But if we don't share data it will not be possible to track patterns."
The number of A. baumannii cases in the hospital ranges from two to 15 a month, but all of them were community rather than hospital-acquired. To limit fatalities, he said, hospitals needed to be alert and heighten their infection control procedures. Basic measures include hand washing and regular disinfecting. All patients needed to be screened before being admitted to any general intensive care units, particularly those coming from other hospitals. He also stressed the need for the population to limit the use of antibiotics to prevent the growth of resistant bacteria.
In 2003, Dh60 million worth of antibiotics were consumed in this country. By 2008, it was Dh146m, according to the healthcare consultancy firm IMS. Consumption of anti-inflammatories such as ibuprofen, aspirin and naproxen has also increased dramatically. By 2008, patients had spent Dh60m on that class of drugs, more than double the Dh25m spent in 2003. Dr Mohamad Yaman, the chief medical officer of Mafraq Hospital, said: "There are more and more antibiotics available and people are taking them. Some homes are like private pharmacies. The problem is, people don't finish the courses."
Mafraq Hospital, one of the largest in the emirate, was one of those that took part in the study. "I know some hospitals have to close whole units because of outbreaks," he said. "I have been here for three years and we have been in control at Mafraq. We come across the occasional case but it's not a major issue for us. "It's a budding problem. It is alarming. We have a whole ward for all bacteria and very tight infection control measures."
In response to the growing antibiotic use in the country, the Health Authority-Abu Dhabi has forged links with the Alliance for Prudent Use of Antibiotics. It will study policy and regulation requirements, raising awareness and proposing interventions to curb the misuse of the drugs. munderwood@thenational.ae
