Superbug on the rise: Hong Kong University researchers call for centralised reporting of cases, more screening
- Public hospitals saw worrying rise in cases of CPE, a superbug resistant to powerful antibiotics
- Medical specialists call for care home residents to be screened, as elderly are more vulnerable
Medical researchers at the University of Hong Kong (HKU) have called for citywide action to track a drug-resistant superbug that made its presence felt in hospitals before the Covid-19 pandemic.
They suggested setting up a centralised reporting platform for all cases of Carbapenemase-producing Enterobacteriaceae – commonly referred to as CPE – to combat the surge.
Medical specialists told the Post the presence of this superbug was worrying, and Hong Kong needed to step up screening for it, especially among the elderly in care homes.
The Hospital Authority revealed in 2019 that CPE cases more than doubled from 473 in 2017 to 972 in 2018. It told the Post this week that it did not have updated figures since then, including through the Covid-19 pandemic.
The HKU team which examined the 2018 data and cases from the earlier decade said the CPE superbug was especially worrying because it was so hard to treat.
“This bacteria can resist many types of drugs, even Carbapenemase, which is generally considered the last line of defence in antibiotics. An infection of CPE will restrict the type of treatment available, while a severe infection can even be incurable,” said Dr Celine Chui, assistant professor in HKU’s school of nursing and public health.
The rise of drug-resistant bacteria has been recorded for some time, especially among patients in hospitals, with older people found to be particularly vulnerable. The rise has been blamed on the excessive prescription and use of antibiotics.
“Antibiotics are the main drugs to treat bacterial infections, but antimicrobial resistance will get more severe if antibiotics are abused,” said Chui. “When antibiotics lose their potency, there will be fewer or even no drugs that work for patients, therefore threatening global health in the long term.”
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Another common superbug, Methicillin-resistant Staphylococcus aureus (MRSA), has also showed a rising trend in Hong Kong in recent years. Cases of MRSA detected in the community rose five times between 2007 and 2016, with about 1,000 cases each year from 2014 to 2016.
The HKU team found that CPE was present in 1.9 out of every 1,000 people warded at public hospitals in 2018 data, a sharp increase from only 0.01 in 2011.
Among the factors behind the rise, the researchers singled out the increased use of the powerful antibiotic Carbapenemase as an “independent dangerous factor”. About 1.37 in every 1,000 patients had a history of using – and possibly misusing – the drug, they found.
Chui said those infected by superbugs could have no symptoms, and their condition could go unnoticed without regular screening. All the time, the superbugs could cause serious harm to their health.
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“Antimicrobial resistance could also threaten food safety, as the drug-resistant bacteria could enter the food chain through faeces, contaminated soil or water, and go into vegetables and other crops,” she said.
Chui and her team recommended that the government set up a unified monitoring and reporting platform pulling together the existing separate systems of the Hospital Authority, public laboratories under the Department of Health, and food authorities.
Currently, different hospitals screen patients based on various high-risk factors. While some patients with a history of medical infection could get accepted for screening, others might be excluded, leading to a missed opportunity in detecting and preventing the spread of the superbug.
Chui said authorities needed to strengthen screening criteria by having standardised guidelines, and educate the public on the use and misuse of antibiotics.
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Commenting on the research team’s findings, Dr Joseph Tsang Kay-yan, head of the Medical Association’s advisory committee on communicable diseases, said he was worried that superbug cases continued rising through the Covid-19 pandemic which had stretched public hospital resources to the limit.
The spread of superbugs was more likely in hospitals that were more crowded, he added.
“A centralised reporting system by public and private practitioners could help shine a spotlight on the scale of the problem in the city, and where the problem lies exactly,” he said.
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He said some superbugs were believed to have moved from spreading mainly within hospitals to spreading in the community, naming MRSA as one that was more frequently detected in his patients in the community.
To stem the spread of superbugs, respiratory medicine specialist Dr Leung Chi-chiu said more screening should be done for high-risk groups, such as elderly people in care homes.
Last November, the Hospital Authority started a pilot scheme in Yau Tsim Mong and Hong Kong Island West districts to screen residents at selected care homes for MRSA.
Leung urged the authority to extend the screening to all care facilities in the city, and also offer voluntary testing to elderly people.
