Hospital-acquired infections: the threat of superbugs in intensive care, affecting 20 per cent of patients
In Italia, there are around 500,000 infections and at least 11,000 deaths recorded each year, accounting for a third of the European total, with estimated costs of 783 million
Key points
The development and use of antibiotics have revolutionised the approach to the treatment and prevention of infectious diseases and infections, paving the way for the evolution of modern medicine. However, their continuous and, often, inappropriate use has increased selective pressure, favouring the emergence, proliferation and spread of resistant strains. Furthermore, the emergence of pathogens resistant to multiple antibiotics simultaneously (multidrug resistance) has further reduced the possibility of effective treatment. Hospitals are particularly at risk due to a combination of factors linked to the frailty of patients, the presence of resistant germs and the medical procedures required for treatment.
The issue of healthcare-associated infections (HAIs) has long been a focus of attention for health authorities worldwide. Italia, too, is grappling with the problem: it is estimated that around 500,000 hospital-acquired infections occur in our country each year, with a third of cases caused by antibiotic-resistant pathogens. The figures presented during a meeting in Rome – held at the Biagio D’Alba Auditorium of the Ministry of Health and attended by institutions, experts in hygiene and public health, clinical professionals and representatives from the academic world – are alarming. In fact, Italia holds the European record for the incidence and mortality rates associated with antibiotic-resistant microorganisms, with at least 11,000 deaths per year, accounting for one-third of the European total. The prevalence of antibiotic-resistant infections in acute care wards stands at 6–8 per cent, whilst in intensive care units it reaches peaks of 20 per cent. The economic impact on the National Health Service is estimated at 783 million euros per year.
The main problem facing the National Health Service
“Antimicrobial resistance is the main challenge facing the National Health Service,” emphasises pharmacologist Francesca De Plato, head of the hospital pharmacy at the Teramo Local Health Authority, an expert in biological and chemical risks in healthcare settings, disinfection, personal protection and antimicrobial stewardship. The negative consequences are both direct and indirect, as they can affect patients’ health or prevent timely treatment for other medical conditions, irreversibly compromising the outcome and significantly altering life expectancy (not to mention the dramatic impact on healthcare costs).” The issue of superbugs brings to the fore the urgent need to ensure the correct and informed management of the tools available to doctors to keep these infections under control. “The selective pressure exerted by the excessive or inappropriate use of antibiotics, combined with the extraordinary evolutionary capacity of bacteria, accelerates the emergence of superbugs,” observes De Plato. Understanding the molecular mechanisms and control strategies is essential for preserving the effectiveness of antibiotics – drugs that have changed the course of human history – and for developing programmes capable of bringing about a significant shift in the approach to antibiotic therapy.”
Prioritising preventive measures
Experts aim to highlight how the majority of healthcare-associated infections can be prevented through rigorous infection prevention measures, as well as through control and surveillance activities and the appropriate management of antibiotic therapy. A key element is the ‘One Health’ approach, which integrates human, animal and environmental health, alongside the urgent need to strengthen a culture of prevention amongst healthcare workers and the public. However, hygiene procedures are also important, as are the uniforms worn by healthcare workers – now available as reusable PPE – aerosolised disinfection in confined healthcare settings, the cleaning and disinfection of surfaces using ozonated water produced on-site, recognised at European level as an active ingredient for surface disinfection and also cited by INAIL and ANMDO among the useful solutions for environmental hygiene.
The measures introduced by the government
“Antibiotic resistance is not a problem for the future but one we face today, with thousands of deaths each year due to a lack of treatment options,” points out the Under-Secretary of State for Health, Marcello Gemmato, emphasising the importance of the sustainability of the National Health Service, established in 1978 in a context very different from today’s: today, Italia has one of the longest-living populations, with a high prevalence of chronic conditions, and new challenges such as Ica and antibiotic resistance represent an additional burden.
