Monday 19 March 2018

Ireland under threat from the march of the superbugs

Professor Martin Cormican
Professor Martin Cormican
Eilish O'Regan

Eilish O'Regan

IRELAND is among the countries where resistant superbugs are on the march, posing particular risk to vulnerable patients whose defences are low.

A recent damning report from the World Health Organisation (WHO), which looked at data from 114 countries, said the growing resistance to these once magic bullets against infections threatens to turn back the clock to a time before antibiotics, when even minor injuries and common infections could kill.

The warning was echoed by Prof Martin Cormican, Prof of Bacteriology at NUI Galway, who said Ireland is still lagging behind countries like Sweden and Norway in its overuse of antibiotics and spread of infection.

He said: “When you compare Ireland to those countries, we still use a lot of antibiotics per head of population. We use more of the broad spectrum antibiotics and, as a country, we don’t do infection control as well.

“The resistance is driven by how many antibiotics you use in hospital, the community and, to an extent, in agriculture. The other is how good are the systems to stop the antibiotic resistant bacteria from speading from one person to another.”

Prof Cormican said we in Ireland have “big problems across the board. You have bugs that are resistant to not just one, but five or six or seven antibiotics. You are down to two or three options so sometimes the drugs you are down to are harder to use, more toxic.

“In Ireland, bacteria that are resistant to everything are still very rare. But those that are increasingly resistant to drugs that are easier to use are increasingly common. Treating doctors are finding themselves using drugs that are less safe and effective.”

He said there are no estimates of how many people are dying in Ireland as a result of resistance. “It is hard to know what the figures mean. The vast majority of people who die having had an antibiotic associated infection were already pretty sick.

“The likelihood that it will do any harm to anyone in the full of their health is not great. The problem poses the biggest threat to those who are already the most vulnerable,” he added.

The diseases which are under threat of antibiotic resistance include:

• Tuberculosis — this should be treatable within six months once people are prescribed a course of antibiotics. But resistance has emerged to common medicines and the wider range of pharmaceuticals used to treat the disease.

• Gonorrhoea — there is just one antibiotic left capable of treating it and even this, ceftriaxone, is said to be becoming less effective.

• Klebsiella — this can cause a wide range of conditions including pneumonia, urinary tract infections, septicaemia, meningitis and diarrhoea.

• Syphillis and Diphtheria — resistance to these diseases has not yet emerged but the fear is that it could happen, posing a serious public health threat.

In Ireland, bacteria that are resistant to everything are still rare.



SOME counties have no nursing homes which cater exclusively for the complex needs of people with dementia, according to a new survey.

Dublin, Carlow and Wicklow are without these facilities, while counties Cavan, Monaghan, Cork, Donegal and Galway are over-supplied.

The findings emerged in a national survey of public, private and voluntary homes across the Republic led by Suzanne Cahill, Trinity College’s Associate Professor of School of Social Work and Social Policy.

A total of 602 nursing homes were surveyed on the provision of dementia care to residents. The survey found 54 homes cater exclusively for people with dementia and one third are privately run. There are 1,034 people with dementia resident across these 54 facilities. This figure represents 2 per cent of all people estimated to have dementia in Ireland or 4.5 per cent of the total number of older people living in long stay residential care.

Only 5 per cent of residents in these homes were aged under 65 and only one person had Alzheimer’s disease related to Down Syndrome.

“The average number of people living in each SCU was 19, a figure far in excess of best practice recommendations,” said the survey.

A significantly larger proportion of privately owned homes, compared with HSE and voluntary sector, reported that all nursing staff and health care attendant staff had undergone dementia specific training.

There are end-of-life policies in evidence in most of these homes. However, a small minority either always or sometimes discharged their residents dying with dementia to other nursing homes or to acute care.

The survey found that despite the expected increase in prevalence of dementia in Ireland, no significant expansion in supply is likely in the foreseeable future. The professor said the research was primarily undertaken to gain a better understanding of the numbers and location of dementia specific residential care settings, and until recently no register of these existed. “The findings shed new light on the location, lay out and ethos of residential care settings that cater exclusively for the needs of people with dementia.They show a significant under-supply in this type of specialist care provision in areas around the country where we know demand will in the future be significant.

“Private nursing homes are providing the main bulk of specialist dementia care; they are expected to comply with specific criteria yet they receive no additional payments from the government for residents with very high dependency needs,” she said.



MORE than 5,303 children are waiting over two years to start orthodontic treatment, with the highest number in the west, new figures show.

Some 647 of these teenagers are waiting more than four years — 520 of whom are in the HSE Dublin and north east region, according to Health Minister James Reilly.

Overall, there are 15,697 children on a waiting list for this treatment in 2014, he said in a parliamentary reply.

Orthodontics is a type of dentistry that aims to improve the appearance, position and function of crooked or abnormally arranged teeth.

In some cases, abnormal development of the teeth and jaw can affect the shape of the face, which could cause psychological and emotional problems, such as lack of self-confidence.

Dr Reilly said the HSE provides orthodontic treatment to those who have been assessed and referred for treatment before their 16th birthday.

“It should be noted that the nature of orthodontic care means that immediate treatment is not always desirable.

“It is estimated that in up to 5 per cent of cases, it is necessary to wait for further growth to take place before treatment commences.”

 Patients are assessed by the HSE Orthodontic Service under the modified Index of Treatment Need which prioritises those needing the most urgent care.

The patients with the greatest level of need, |such as Grade 5 or Grade 4, are provided with |the earliest treatment by the HSE, he added. Some figures are unavailable due to staff |shortages so the real number waiting is probably higher.

The waiting list is longest in the west (4,921), followed by Dublin mid-Leinster (3,944), Dublin and the north east (3,497), the HSE south (3,337).

Another review of orthondontic services for |children is underway.

Delays in treatment under the Health |Service Executive (HSE) persist and they are exacerbated by the moratorium on recruitment.

The HSE north east recently revealed that some children who were deemed eligible for orthodontic treatment, have been on a waiting list since January 2008.

It received additional staff but also lost some and they have not been replaced.

In a submission to the HSE, it requested that other regions which are better staffed agree to accept children from HSE north east for treatment in their area, or to redeploy staff from their areas.

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