Hong Kong superbug surge prompts fears over ‘big gun’ antibiotics

Statistics reveal a seven-fold rise in one particular type of superbug case, more than 30 per cent of which were imported

PUBLISHED : Thursday, 28 April, 2016, 11:37pm
UPDATED : Thursday, 28 April, 2016, 11:43pm

The health consequences of overreliance on antibiotics are in the spotlight again after a seven-fold increase in drug-resistant superbug cases in public hospitals.

The number for one particular type of drug-resistant superbug rose from 19 cases in 2011 to 134 last year following the increasing use of “big gun” antibiotics for patients who were critically ill or resistant to regular drugs.

One new superbug infection every 18 minutes in Hong Kong public hospitals

The Hospital Authority is stepping up efforts to curb in particular cases of carbapenemase-producing enterobacteriaceae (CPE), which is a kind of gut bacteria.

Carbapenemase are enzymes produced by bacteria that can break down “big gun” antibiotics called carbapenems.

Starting in July, patients will be screened for superbugs if they have spent time in hospitals outside Hong Kong within the past year, instead of the current six months.

Among the 134 cases recorded among public hospital patients last year, 102 were of a more severe type which had higher transmission rates. More than 30 per cent were imported, with half linked to mainland hospital stays within the previous six months.

Dr Dominic Tsang Ngai-chong, the Hospital Authority’s chief infection control officer, said the rise of CPE infection was a concern.

“The rise is pretty big ... If someone has been infected by CPE, choices of antibiotics are few. Doctors have to use the ‘big gun’ out of the ‘big guns’,” Tsang said. The actual number of cases was still on the low side, he said.

Up to 85 per cent of cases were discovered through screening, meaning they were asymptomatic and could infect others through contact with unwashed hands and through other means.

Superbug cases on the rise at Hong Kong’s public hospitals

Patients found to have CPE through screening would be isolated to avoid infecting other patients with weak immune systems, Tsang said.

“There is no treatment for CPE carriers but isolation only,” he said. “It has caused a heavy workload.”

He suggested larger numbers of weaker patients could mean more CPE infections.

“Those who are older, have underlying diseases or are on ventilators are high-risk patients,” Tsang said.

The number of patients infected by another superbug, methicillin-resistant Staphylococcus aureus, or MRSA, jumped from 0.146 cases per 1,000 patients last year to 0.182 in the first quarter of this year.

The use of “big gun” antibiotics saw a steady increase, with an overall figure of 89 out of every 1,000 hospital patients using them in the first quarter, a rise from 81 last year.

Intensive care units, which have prescribed the drug to 441 patients so far this year, remained the biggest users.

This was despite doctors being asked to observe “four rights” when prescribing antibiotics – right indication, right choice, right dosage and right duration.

“I would not rule out the possibility that doctors are not adhering to the four rights,” Tsang said.