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Introduction: MDROs Impact on Patient Care and Control Strategies
The study is based on the analysis of two articles. The first article is titled as “First case of multidrug-resistant fungal species Candida auris recorded at Hong Kong's Princess Margaret Hospital”, which is written by Danny Mok and Elizabeth Cheung. This article is based on discussing the effect, transmission and preventive measures for MDRO in Hong Kong through the analysis of 48-year-old man as the case study subject. The second article is d as “Superbug cases on the rise at Hong Kong's public hospitals” which is composed by Shirley Zhao. The second article provides an overview of the recent trends in MRDA and its infection control measures. MDRO is defined as the organisms that have established resistance to diverse range of antibiotics (Liana et al., 2019). The purpose of the study is to identify the transmission route of MRDA and MDRO, recognise susceptible population group to MDRO, analyse the effect of MDRO in Hong Kong and explain the infection control measure for MDRO.
Discussion on MDRO Transmission, Vulnerability, and Control Measures
From the works of Cheung and Mok (2019), it is observed that the nosocomial outbreaks at health care facilities is one of the major modes of transmission for the Multi Drug Resistant Organisms (MDRO) such as the Candida auris. Nosocomial outbreak is defined as the infection which that was acquired while receiving treatment from the healthcare facilities. The transmission of the Candida auris via nosocomial infections occurs in cases where the air droplets comprising the microbial organisms from the infected person are spread across the air by the acts of sneezing or coughing and are deposited on the host's body. The prevalence of such transmission is in coherence with indirect contact route of transmission since it emphasises the spread of disease causing microbes to the healthy person from the infected person through air droplets and such aspect is met by the transmission is met by the Candida auris since it spreads from the infected to the healthy person via respiratory droplets. Analogous observation can be witnessed in the work of Lingor et al. (2022) as the authors suggest that the indirect contact of transmission shares a positive association with the spread of microbes through air droplets. Furthermore, Kaushik et al. (2015) have supported that the most of the fungal infections are spread through indirect route of transmission Therefore, it is analysed that the spread of the Candida auris through nosocomial outbreak adheres to an indirect route of transmission.
In the finding of Heung et al. (2023), it is observed that the spread of the multidrug-resistant acinetobacter (MDRA) microbe is driven by the contact with infected animals. The spread of such microbe is associated with the direct route of transmission since this transmission route is characterised by physical contacts such as touch. Hence, it is analysed that the spread of the multidrug-resistant acinetobacter (MDRA) is driven by direct contact.
In the article of Heung et al. (2023), it is stated that the individuals with compromised immunity is the most vulnerable population to being infected by the multidrug-resistant acinetobacter (MDRA). The reason behind the microbe's affinity towards such particular population is attributed to the fact that the multidrug-resistant acinetobacter (MDRA) proliferates extremely fast in the host body and the compromised immunity in the host is not able to produce antibodies in such high rates to neutralise the amplification of the (MDRA). This reduces the barrier that is posed to the multidrug-resistant acinetobacter (MDRA) in terms of infecting the host and renders this target population suitable for the multidrug-resistant acinetobacter (MDRA). Similar evidence can be observed in the works of Montefour et al. (2018) as the results suggest that the emergence of multidrug-resistant acinetobacter (MDRA) such as Acinetobacter Baummani depicts a positive relationship with the individuals who are in possession of low antibody count due to weak immunity systems. Therefore, it is analysed that the absence of low antibody production capacity of the immune system is responsible for making the immunity compromised individuals as the target population for the multidrug-resistant acinetobacter (MDRA).
In the statement of Cheung and Mok (2019), it is observed that the recent instance of Multi Drug Resistant Organisms (MDRO) infection such as the Candida auris has been highlighted by the contamination of the microbe by a 48-year-old man. This implies that the Multi Drug Resistant Organisms (MDRO) infection has been targeting the middle aged population. The reason behind such high susceptibility of the target population group to the microbial infection of the Multi Drug Resistant Organisms (MDRO) is attributed to the fact that the middle age population is associated with higher consumption rate of antibiotics and antifungals and this unreasonable consumption of antibiotics renders their clinical effect on killing the Multi Drug Resistant Organisms (MDRO) ineffective since this prolonged and high dose of antibiotics makes it easier for MDRO to develop resistance against these drugs. In the works of Wang et al. (2019), it is supported that higher instances of Multi Drug Resistant Organisms have been witnessed amongst the middle age population due to their high intake of antibiotics medication. This is furthermore evidenced by the fact that more than 50% of the elderly population and middle-aged population has been associated with antibiotic overuse (Portero de la Cruz and Cebrino, 2020; Ying et al., 2014). Hence, it is stated that the high and unreasonable consumption of the antibiotics has been a critical factor for increasing the risk and susceptibility of the middle age population to the contamination of the Multi Drug Resistant Organisms (MDRO).
In addition to that, the individuals with impaired immunity is also vulnerable to the infection from the Multi Drug Resistant Organisms (MDRO) since these organisms take over the host cells without the significance intervention of cell mediated immunity response or natural killers cells. Therefore, it is observed that middle aged population as well as the impaired immunity population are the two population category that is targeted by the Multi Drug Resistant Organisms (MDRO)
From the assessment of Cheung and Mok (2019), it is stated that the pulmonary embolism is a major impact of (MDRO) infection such as the Candida auris in Hong Kong. Pulmonary embolism is a blood clot that occurs in the lung and prevents the blood flow from the lung to the artery (Lambrini, 2018). This has also affected the healthcare system of Hong Kong since it was the first case of Candida auris and its spread might lead to an epidemic in Hong Kong. In an attempt to address the spread of the Candida auris, the healthcare system has been investigating the individuals who have come in contact with the 48-year old patient after the patient's visit to Switzerland and has been isolating the individuals who are showing symptoms of possible contamination.
In the article of Cheung and Mok (2019), it is observed that the infection control measures for controlling the MDRO's in Hong Kong include disinfection of the patient's ward through fumigation, full screening of all the patients in the same ward through fungal culture and performing an extensive outbreak investigation. This measure of disinfecting patient's ward through fumigation is extremely important since the fungal infection could recur if the spores of the fungus survives in the patient's environment and the use of fumigation as a disinfectant kills the spores and fungus. Choi et al. (2017) have supported that the use of fumigation has serving to the benefits of reducing fungal outbreak. The second measure is significant for preventing transmission of MDRO since MDRO is highly contagious and the screening of the patients through fungal culture identifies any possible victim, which needs to be isolated, and, in turn, reduce the transmission risk.
Moreover, the study performed by Heung et al. (2023) suggests that the sanitation, reduction of occupancy levels in the wards and the decreased workload for the employees are effective infection control measures for reducing the threats of the (MDRA). The first measure is critical because the increase in occupancy is associated with the rise in moisture level within the patient wards which proves to be a facilitative environment for the MDRO to thrive and the reduction of the occupancy decreases the provision of such growth environment for the MDRA, thereby, decreases the chances of transmitting MDRA. The third measure of decreased workload is significantly important since the high workload influences the staffs to compromise with sanitation approaches to find time for addressing their other commitments and such compromises creates a significant scope for bacterial transmission since the lack of sanitation shares a positive association with MDRA. Peters et al. (2022) have supported that the 58% of the Healthcare associated infections (HAI) such as bacterial outbreak is explained by the absence of proper sanitation protocols. Therefore, it is observed that these measures are of critical importance to preventing MDRO outbreak in Hong Kong.
Conclusion
The findings of the study suggest that the MDRO's such as Candida auris spread through indirect route of transmission whereas the MRDA disperse through direct route of transmission. The results of the studies that the lack of sanitation and overcrowding of patent wards are the two key issues that needs to be addressed when it comes to controlling MRDA. The article has also shed on the importance of disinfection of the patient's ward through fumigation, full screening of all the patients in the same ward through fungal culture and performing an extensive outbreak investigation to prevent MDRO infections in Hong Kong.
References
- Cheung, E. & Mok, D. (2019). First case of multidrug-resistant fungal infection recorded in Hong Kong. (2019). Retrieved from https://www.scmp.com/news/hong-kong/health-environment/article/3016437/first-case-multidrug-resistant-fungal-species
- Choi, H., Lee, B. H., Moon, Y. S., Kim, K., Lee, H. S., & Lee, S. E. (2017). Antifungal and antiaflatoxigenic effects of a fumigant, ethanedinitrile, on Aspergillus flavus. Applied Biological Chemistry, 60(5), 473-476. https://doi.org/10.1007/s13765-017-0301-0
- Heung, S. (2023). Hong Kong Hospital Authority warns of surge in 2 superbugs, turns to AI in fight against antibiotic overuse. Retrieved from https://www.thestar.com.my/tech/tech-news/2023/11/24/hong-kong-hospital-authority-warns-of-surge-in-2-superbugs-turns-to-ai-in-fight-against-antibiotic-overuse#:~:text=About%209%2C500%20new%20cases%20of,of%20late%20September%20this%20year.
- Kaushik, N., Pujalte, G. G., & Reese, S. T. (2015). Superficial fungal infections. Primary care: clinics in office practice, 42(4), 501-516. http://dx.doi.org/10.1016/j.pop.2015.08.004
- Lambrini, K. (2018). Pulmonary Embolism: A Literature Review, American Journal of Nursing Science, 7(1), 57-61 http://dx.doi.org/10.11648/j.ajns.s.2018070301.19
- Liana, P., Patricia, V., & Agatha, C. (2019, July). Multidrug-resistant organisms (MDRO) patterns of GICU patients in Dr Mohammad Hoesin Hospital Palembang. In Journal of Physics: Conference Series (Vol. 1246, No. 1, p. 012025). IOP Publishing. http://dx.doi.org/10.1088/1742-6596/1246/1/012025
- Lingor, P., Demleitner, A. F., Wolff, A. W., & Feneberg, E. (2022). SARS-CoV-2 and neurodegenerative diseases: What we know and what we don't. Journal of Neural Transmission, 129(9), 1155-1167. http://dx.doi.org/10.1017/ice.2021.57
- Montefour, K., Frieden, J., Hurst, S., Helmich, C., Headley, D., Martin, M., & Boyle, D. A. (2018). Acinetobacter baumannii: an emerging multidrug-resistant pathogen in critical care. Critical care nurse, 28(1), 15-25.
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