Between January and March of this year, cases of patients infected with super-resistant bacteria were recorded in three hospitals in Salvador. In April, the Department of Health of the State of Bahia (Sesab), issued a technical note warning of the risk of dissemination of the enterococcus microorganism (in the image below), which is resistant to the antibiotic vancomycin, in hospital units. The secretariat does not say how many people were infected in total or which hospitals were. There is also no information on patients infected with resistant enterococcus outside the capital.
The well-known warning made by doctors often to people to avoid taking antibiotics unnecessarily because it can help the development of super bacteria is precisely what explains the vancomycin-resistant strain of enterococcus. Bacteria are able to evade the effectiveness of the antibiotic, which implies the reduction of drug options to treat serious infections.
In 2019, four hospital units also registered infections of this type in Salvador. Sesab, however, does not report how many patients were reached at the time and which health units were. Infections of this type do not usually affect healthy people, but those who are already hospitalized, according to infectious disease specialist Fábio Amorim.
This type of bacteria has great potential for dissemination in health facilities because it is resistant to drugs that treat diseases caused by microbes in general, as infectologist Antônio Bandeira explains. “This antibiotic resistance points out that the bacterium is often resistant to many antibiotics and this [vancomicina] is one of the main used in the treatment. In addition, the gene can be quickly transmitted to other bacteria, which can lead to an outbreak in hospital units”, says the doctor.
The risk is greater for inpatients and patients with access [como cateteres para colocação de soro ou medicamento intravenoso] or intubated. “Every patient inside the hospital is already weakened. If this bacterium still causes nosocomial infections, as it often does, it will further weaken those who are already fragile”, highlights Antônio Bandeira.
Enterococcus can be responsible for infections in various parts of the body, such as endocarditis (which affects the valves of the heart), urinary tract and abdomen. Therefore, they are considered ‘opportunistic’ bacteria. “Often, the infection is associated with the colonization of catheters by bacteria, so there can be a bloodstream infection or they can colonize the urinary catheter and the person has a serious urinary infection”, says Bandeira.
If the infection occurs through the blood, the condition can worsen to sepsis. This means that the bacteria invades different parts of the body, transported by the bloodstream. The infectologist Fábio Amorim points out that as the microorganism is resistant to its main type of treatment, the antibiotic vancomycin, the options are reduced.
“The risk is due to the fact that the patient is infected with a pathogenic agent that can lead to infection in the most diverse sites, such as skin, lung, heart, kidneys and bones, and still have restricted therapeutic options”, explains the doctor.
Other antibiotic options that can be used in case of vancomycin resistance are daptomycin and linezolid. A box of the latter, with 28 pills, can cost R$ 6,700, according to the Farmaindex platform. The site conducts research and compares various types of medications and was created in March 2020.
Enterococcus-type multidrug-resistant microorganisms were considered a high priority for surveillance by the World Health Organization (WHO) in 2017. Therefore, the alert of infections of this type is important for hospitals and health facilities to take measures to prevent outbreaks.
Among the measures indicated by Sesab are: isolation of the infected patient in a private room, implementation of standardized cleaning and disinfection procedures, maintaining equipment for the exclusive use of infected people and carrying out an active surveillance culture to investigate possible outbreaks. Surface disinfection is important because enterococci can survive in these locations for long periods.
For healthy people to visit hospitalized, infectologist Antônio Bandeira says that there are no defined protection criteria. “For people on an individual level, there is not much recommendation. It’s actually more related to hospital management,” he says.
Despite this, Sesab recommends correct hand washing whenever possible.
Pandemic may have contributed to more resistant strains
Long hospitalizations caused by covid-19 during the pandemic may have favored the development of bacterial resistance to antibiotics, explains a technical note from Sesab. Many patients who had the infection of the new coronavirus needed to be admitted to Intensive Care Units (ICU) and used invasive devices such as intubation, mechanical ventilation and catheters.
“All these procedures led to bacterial infections and the intensive use of antibiotics, which may have favored the emergence of this type of strain”, explains doctor Antônio Bandeira. In addition, Sesab points out that the “difficulties to implement measures to prevent and control infections” in health units in the state may have contributed to the appearance of cases.
“The pandemic created conditions that favor the spread of microorganisms resistant to antimicrobials in health services: an increase in the number and length of hospitalization of patients with covid-19; critically ill patients with prolonged use of invasive devices and intensive care; reduction in the number of health professionals and an increase in the workload”, lists the technical note.
*With the guidance of the deputy head of reporting Monique Lôbo.