Thousands tested positive for ‘superbugs’ in Irish hospitals last year

Almost 7,000 patients tested positive for potentially fatal healthcare-associated infections in Irish hospitals last year, new figures show.

The data, obtained by The Irish Times through an analysis of official reports and Freedom of Information requests, found 1,065 patients acquired Clostridium difficile (C diff) or Staphylococcus aureus (S aureus) bloodstream infections in hospitals during 2021.

S aureus is one of the leading causes of life-threatening bloodstream infections, such as sepsis and endocarditis, while C diff are bacteria that live in the gut and can cause severe illness, particularly in older people, who can get distended stomachs and sometimes need surgery.

There were 352 cases of S aureus bloodstream infections, which would include both methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA), acquired in hospitals in 2021.

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Beaumont had the highest number of S aureus bloodstream infections at 37, with the Mater having 31 and both St James’s and St Vincent’s each having 30.

There were also 717 cases of hospital-acquired C diff last year. However, some hospitals were unable to provide figures for certain months in 2021 due to the impact of the cyberattack on the HSE systems, which could mean the true figure is higher.

[ Staff and bed shortages compound the ‘superbug’ threat to patients in hospital ]

The Mater had the highest number of hospital-acquired C diff cases, the HSE figures show, at 65, followed by Galway University Hospitals at 64 and Beaumont Hospital at 63.

There were also 3,782 cases of hospital-acquired Covid-19 last year.

Dr Eimear Brannigan, the HSE’s clinical lead on antimicrobial resistance and infection control, said hospital-acquired superbugs “absolutely” contributed to a number of patient deaths annually.

“It’s difficult to attribute mortality to one particular organism. But absolutely, there’s no doubt [that they do contribute to deaths]. Even without the resistant component, if these organisms are in your blood – sepsis itself has a mortality associated with it,” she said.

Dr Susie Frost, a consultant microbiologist who leads the HPSC microbiology and infection control team, said the spread of superbugs was “100 per cent” due to infrastructure and staff.

“If you fix either, it wouldn’t fix it. We have too many patients for too few beds, particularly isolation beds. And then we don’t have enough staff to look after them. Day time, often we just about muddle through, but wards at night you could have two nurses looking after 42 patients,” she said.

“All it takes is one person to fall and you’ve got 41 patients with nobody able to be on hand. Hands can’t be washed running between them or doing medication rounds; we don’t have enough staff: doctors, nurses, and healthcare assistants.”

Every hospital had an “isolation priority list”, she added, which means patients are housed in order of priority.

“Examples of must isolate include TB, CPE, airborne infections such as measles and active C diff infection. For pathogens like VRE and MRSA, consideration is given to the patient themselves – are there incontinence issues, drains, catheters or surgical wounds to decide who to isolate first?” she added.

The HSE said hospitals varied by size and case-mix and that could have an important impact on the number of superbugs, meaning those resistant to antibiotics, detected in patients.

Furthermore, 682 cases of CPE (Carbapenemase producing Enterobacteriaceae), an infection of antibiotic-resistant gut bacteria, were detected by Irish hospitals in 2021. These are cases identified through screening, meaning they were not necessarily acquired in hospital.

University Hospital Limerick had the highest level of CPE detections at 119, followed by Galway University Hospitals at 68.

There were also at least 1,133 cases of VRE (Vancomycin-resistant Enterococci) recorded in 13 Irish hospitals last year, according to figures obtained by The Irish Times through Freedom of Information laws. VRE is another antibiotic-resistant bacterial infection which can cause urinary tract and wound infections. VRE can cause a serious infection if it gets into blood, kidneys, bladder or body tissues.

These cases include both patients who are “colonised” with, or carrying, the organism, as well as those with bloodstream infections. Official Health Protection Surveillance Centre (HPSC) figures for VRE include only bloodstream infections, of which there were 167 cases recorded.

Furthermore, 303 cases of ESBLs were detected, according to HPSC figures. Extended-Spectrum Betalactamese, or ESBLs, are common antibiotic-resistant bacteria, which can cause a serious infection if they get into the blood, kidneys, bladder or body tissues.

The presence of most of the superbugs decreased during the Covid-19 pandemic, but have since increased again, with some now reaching levels higher than 2019.