He held up his hands. “This is number one,” Dimopoulos said, for transmission of the bacteria. “This and the stethoscope.”
BY NAOMI KRESGE AND JASON GALE | BLOOMBERG NEWS
BERLIN — Greek doctors are fighting a new invisible foe every day at their hospitals: a pneumonia-causing superbug that most existing antibiotics can’t kill.
The culprit is spreading through health centers already weighed down by a shortage of nurses. The hospital-acquired germ killed as many as half of people with blood cancers infected at Laiko General Hospital, a 500-bed facility in central Athens.
The drug-resistant K. pneumoniae bacteria have a genetic mutation that allows them to evade such powerful drugs as AstraZeneca’s Merrem and Johnson & Johnson’s Doribax. A 2010 survey found 49 percent of K. pneumoniae samples in Greece aren’t killed by the antibiotics of last resort, known as carbapenems, according to the European Antimicrobial Resistance Surveillance Network. Many doctors have even tried colistin, a 50-year-old drug so potent that it can damage kidneys.
“We’re not used to seeing people die of an untreatable infection,” said John Rex, vice president for clinical infection at London-based AstraZeneca, which is developing a new generation of antibiotics. “That’s like something in a novel of 200 years ago.”
The superbug is one among many challenges facing the home of the Hippocratic oath, “first do no harm.” The government, confronting a $19.3 billion bond payment on March 20, is trying to arrange financing to avert a collapse of the economy. Partly as a result, the health system is in crisis, with some life-saving drugs in short supply and hospitals struggling to pay their bills.
Greece has the lowest nurse-to-patient ratio in Europe and one of the highest rates of antibiotic use — and abuse — on the continent, hindering the attack on the infection.
George Daikos, an associate professor of medicine at Laiko General, won one battle last year in the ward for people with leukemia and other blood disorders by separating people carrying the bacteria from uninfected patients and forcing busy nurses to wash their hands more often.
Fighting the infection in the rest of the hospital, where one nurse cares for as many as 20 patients, casts Daikos as Sisyphus, the mythological king doomed to roll a boulder up hill, only to watch it tumble down again, over and over for eternity.
“We know what to do, but if you don’t have the personnel, you can’t do it,” Daikos said in an interview in his office, deep in a side wing of the sprawling hospital. “If you don’t have enough nurses, how can I assign a dedicated nurse to carriers?”
The superbug, dubbed KPC, first appeared in Greece in 2007 after spreading through the United States and then Israel. By 2010, Austria, Cyprus, Hungary and Italy were also experiencing an increase in cases, the European Centre for Disease Prevention and Control said in a surveillance report in December.
In the worst outbreaks, as many as half of the people who develop a blood infection because of KPC are killed, doctors in Toronto said in a review article in the journal of the Canadian Medical Association last year.
While Greece is striving to curb KPC, the country faces fewer problems with multidrug resistant, so-called Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus, the superbug better known as MRSA, than do other nations, said Spyros Pournaras, an associate professor of medical microbiology at the University Hospital of Larissa. Pournaras helped write the Oxford Journals article that identified KPC’s first sweep of a Greek hospital in 2007.
“We have problems,” he said in an interview in Athens. “But let’s not generalize that we’re a threat for Europe.” Greece also doesn’t have so-called Gram-negative bacteria with gene mutations known as NDM, IMP and OXA-48, which are common elsewhere, Pournaras said.
Even so, Greece has a bigger problem than do other countries because its doctors over-prescribed antibiotics, said George Dimopoulos, an associate professor of intensive care medicine at Attikon University Hospital in Athens. Greeks used more antibiotics than residents of any other European country, according to a 2009 survey by the European Surveillance of Antimicrobial Consumption. Antibiotic use outside hospitals was more than twice the median.
Another issue is the lack of nurses, Dimopoulos said. For example, an overworked nurse might change a catheter or a wound dressing without washing her hands, he said — a prime opportunity for bacteria to hop from one patient to another.
He held up his hands. “This is number one,” Dimopoulos said, for transmission of the bacteria. “This and the stethoscope.”