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Deadly hospital-acquired infections (HAIs) might be ‘Disease X’

22 February 2024 | Story André Damons | Photo SUPPLIED

Prof Robert Bragg is a researcher in the Department of Microbiology and Biochemistry at the University of the Free State (UFS) and believes hospital-acquired infections (HAIs) might already be “Disease X”.

During the World Governments Summit, the World Health Organisation (WHO) warned world leaders about the likelihood of a Disease X outbreak, saying it is “a matter of when, not if” a new pathogen and pandemic will strike. If there is an outbreak of this disease tomorrow, the world still would not be ready.

During his speech earlier this month at the summit in Dubai, Tedros Adhanom Ghebreyesus, Director-General of the WHO, said COVID-19 was a Disease X – a new pathogen causing a new disease. He said: “There will be another Disease X, or a Disease Y or a Disease Z. And as things stand, the world remains unprepared for the next Disease X, and the next pandemic. If it struck tomorrow, we would face many of the same problems we faced with COVID-19.”

Though Disease X is a hypothetical placeholder representing yet-to-be-encountered pathogens, Prof Robert Bragg, researcher in the Department of Microbiology and Biochemistry at the University of the Free State (UFS), believes hospital-acquired infections (HAI) might already be “Disease X”. He says data shows that deaths from HAIs will become the leading cause of human deaths. This problem is rapidly growing as most of the pathogens which people contract while in hospital are now resistant to antibiotics, making them very difficult to treat.

Prof Bragg, whose main research is in disease-control, first in the agricultural industry, and now human health, also previously warned about a disease that would make COVID-19, which killed more than seven million people to date globally, look like a dress rehearsal. His PhD student, Samantha Mc Carlie, investigating how bacteria become resistant to disinfectant and sanitiser products. This is a serious problem for the future, as disinfection could be our last line of defence.

Heading for a crisis in health care

“The world is rapidly heading for a crisis in health care regarding hospital-acquired infections. It is common knowledge that we are quickly running out of antibiotics (and antifungals) to treat bacterial and yeast infections. Without antibiotics and antifungals, the outcome of many of these bacterial and yeast hospital-acquired infections will be very severe. They will, unfortunately, in many cases, result in the death of the patient,” says Prof Bragg.

According to him, the WHO suggests that 30% of patients in ICUs in developed countries and 70% in underdeveloped countries will contract a HAI. Of these, the mortality rate can be as high as 70%.

“Most of these infections are caused by multiple drug resistance strains of bacteria such as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species. Additional bacteria and yeast, which can also cause HAIs, such as Serratia species, are also becoming a concern due to their intrinsic higher levels of disinfectant resistance.”

Prof Bragg explains that in 2014, a high-profile review was first published, commissioned by the UK Prime Minister, entitled, “Antimicrobial Resistance: Tackling a crisis for the Health and Wealth of Nations” (the AMR Review). This review estimated that antimicrobial resistance (AMR) could cause 10 million deaths annually by 2050 (The Review on Antimicrobial Resistance 2016). This is the same number of deaths caused by cancer today, making AMR the leading cause of human mortality by 2050. When it was finalised, this report was highly criticised as an over-dramatisation, as when this prediction was made, the number of mortalities related to HAIs was around 700 000 – a very long way off 10 000 000. However, according to recent estimates, five years later, in 2019, 1.27 million deaths were directly attributed to drug-resistant infections globally, and this had reached 4.95 million deaths associated with bacterial AMR (including those directly attributable to AMR) by 2022 (Murray et al. 2022).

The overuse of disinfectants during the COVID-19 pandemic, according to Prof Bragg and Mc Calie, has contributed to the crisis by fostering resistant strains and contaminating environments. Based on the current trajectory of mortalities, the 10 million mark will be reached way before 2050.

Need for a paradigm shift

The researchers say an urgent need to change the paradigm in medicine from “treatment” to “prevention” is necessary and that the old saying ‘prevention is better than cure’ has never been truer.

According to Bragg: “The golden era of antibiotics is rapidly coming to an end. It is highly unlikely that we will discover new antibiotics, and even if we do, the likelihood that the bacteria will already have or will be able to develop resistance in a very short time is highly likely.

“We need to think of what happed with quinolones, where we thought we had won the war with a groundbreaking new antimicrobial agent. The bacteria did not have millions of years of evolution to develop resistance to quinolone, yet in only three years, the first resistant bacteria were isolated. There is currently great excitement around AI-derived new antibiotics. However, the end result is likely to be the same. We need an alternative to treatment – in other words, a paradigm shift.”

Improved biosecurity

Prof Bragg says highly improved biosecurity is the only viable option for disease control in a post-antibiotic era. By using good biosecurity in poultry production, he says the mortality rates were reduced by 50%.

Research has shown a direct link between the environmental microbial load in a hospital and HAIs; with a lower microbial load linked to lower incidence of HAIs including C. difficile infections (Boyce et al. 2008; Suleyman et al. 2018; Umemura et al., 2022). Therefore, the new paradigm is to reduce microbial contamination in the hospital environment to prevent HAIs. If there are fewer dangerous microorganisms in an environment, patient and staff exposure to these microorganisms will decrease, reducing the level of HAIs for staff and patients. However, to reduce the microbial loads in healthcare settings, effective cleaning and disinfection products need to be used.

News Archive

UFS awards degrees at autumn graduation ceremony

2009-04-28

The University of the Free State’s (UFS) autumn diploma and graduation ceremony took place this week in the Arena on the South Campus in Bloemfontein (formerly known as the Vista Campus). This arrangement has been made because of the large-scale renovations to the Callie Human Centre on the Main Campus.

Friday, 24 April 2009
Faculties of Health Sciences, Law and Theology Diploma ceremony

Law student’s achievement excels 80%
Four Law students obtained the LLB degree at this year’s autumn graduation ceremony of the University of the Free State (UFS) summa cum laude and were awarded the Moritz Bobbert Medal. They are from the left: Lezelle Olivier (80%), Albert Nell (91%) and Amanda du Toit (83%). LiFeng Chien were absent during the photo.

UFS awards degrees at autumn graduation ceremony
Today 331 students and five doctorates in the Faculties of Health Sciences, Law and Theology received their qualifications at this year’s autumn graduation ceremony of the University of the Free State (UFS). Michael Molahloe (left) and Mamokete Ntholeng both received their LL.B. degrees in the Faculty of Law.
Photo: Leonie Bolleurs

This year’s autumn graduation ceremony of the University of the Free State (UFS) was held on the South Campus. From the group of students that received their qualification from the Faculty of Law, is from the left: Janine Jonson, Anneska van der Spoel, Andrea Coetzer, and Jo-Mari Visser.
Photo: Leonie Bolleurs

Students in Nursing receive their degree
A group of students from the Faculty of Health Sciences received their B.Soc.Sc. degree at this year’s autumn graduation ceremony of the University of the Free State (UFS). At the occasion were, from the left: Ruth Beukes, Basetsana Panana, and Dipontsheng Tsolo.
Photo: Leonie Bolleurs

UFS Faculty of Health Sciences awards degrees
Liezl Swanepoel (left) and Heide van der Merwe received their BSocSC degrees at the University of the Free State’s (UFS) autumn graduation ceremony.
Photo: Leonie Bolleurs

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Thursday, 23 April 2009
Faculty of Natural and Agricultural Sciences & Chancellor’s Dinner

UFS awards unique doctorate
Dr Rodney Douglas, who had never obtained any formal undergraduate qualification, this week received a Ph.D. in Geography and Geology during the autumn graduation ceremony of the University of the Free State (UFS). The name of his thesis is “A new perspective on the geohydrological and surface processes controlling the depositional environment at the Florisbad archaeozoological site”. He had four papers published in journals that were related to his thesis. He obtained his South African Museums Association Diploma in Biology in 1988 and his M.Sc. in Environmental Biology at the University of Natal, Durban in 1992. He was accepted as a Master's degree student at that university based on research that he had conducted on, amongst others, the diets of reptiles. He has been working at the Department of Herpetology at the National Museum, Bloemfontein since 1984, where he holds the post of Principal Museum Scientist and Head of Department.
Photo: Leonie Bolleurs

Chancellor’s Dinner: UFS honours doctoral students
Last night, the University of the Free State (UFS) honoured students who had received their Ph.D. degrees at the autumn graduation ceremony this past week, at the Chancellor’s Dinner. A total of 25 doctorates were awarded during the respective ceremonies. Attending the occasion were, from the left: Dr Annemarie Kühn, Ph.D. in Chemistry, Prof. Jeanet Conradie, Department of Chemistry at the UFS and Dr Kühn’s promoter, Prof. Teuns Verschoor, Acting Rector of the UFS, Prof. Corene de Wet, Department of Comparative Education and Education Management at the UFS, and Dr Mafu Rakometsi, Chief Executive Officer of Umalusi and former head of the Free State Department of Education who received a Ph.D. in History. Prof. De Wet is Dr Rakometsi's co-promoter and the late Prof. Leo Barnard, former Head of the Department of History at the UFS, who passed away at the beginning of April 2009, was his promoter.
Photo: Leonie Bolleurs

Mrs Annemarie Kilian, Mr Willem Kilian (BSc. Hons) and Prof Stephanus Kilian
Photo: Mangaliso Radebe

Mr Jaco van der Merwe, Mr Renico Pretorius and Mr Rion Terblanche (all BSc. Quantity Survying)
Photo: Mangaliso Radebe

Ms Mamakoanyane Amelia Shata (BSc. Genetics and BSc. Hons. Plant Molecular Biology) and Mrs Maente Adelinah Shata.
Photo: Mangaliso Radebe

Mr Maurice Ambrose and Mr Owen Monk (both BSc. Quantity Survying).
Photo: Mangaliso Radebe

Ms Tobeka Mehlomekhulu (Lecturer: Department of Geography), Mr Neo Mokgosi (BSc. Hons. Genetics) and Ms Nwabisa Mehlomekhulu (BSc. Hons. Food Science).
Photo: Mangaliso Radebe

Mr John Mdane, Mr Fana Mdane (BSc. Information Technology) and Mrs Agnes Mdane
Photo: Mangaliso Radebe

Mr Kevin Vermaak (BSc. Hons. Geohydrology) and Ms Michelle Steenkamp (BSc. Hons. Geology).
Photo: Mangaliso Radebe

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21 April 2009
Faculty of Economic and Management Sciences

Prof. Magda Fourie's daughter graduates
Nadia Fourie, daughter of Prof. Magda Fourie, former Vice-Rector: Academic Planning at the UFS and now Vice-Rector: Teaching at Stellenbosch University, received the B.Com. Law degree.
Photo: Lacea Loader

724 degrees were awarded during the ceremony of the Faculty of Economic and Management Sciences. Here are, from the left: Simon Serutla, B.Com. Accounting, Lourencia Hamuaka, B.Com. Honours in Financial Economics and Investment Management, Sunet Opperman, B. Accounting, and Yolandi Greyling, B. Accounting.
Photo: Lacea Loader

Students in the Faculty of Economic and Management Sciences graduated this week during the University of the Free State's (UFS) autumn graduation ceremony. Altogether 724 degrees were conferred. Here are, from the left: Marie-Louise Lombard, B.Com. Law, Adriaan van der Merwe, B.Com. Law and member of the Student Representative Council (Legal and Constitutional Affairs), Basanio Ncike, B.Com. Economics, and Richard Schooling, B.Com. Banking.
Photo: Lacea Loader

Center for Accounting honours top achievers
The Centre for Accounting at the University of the Free State (UFS) honoured the top ten students in the third-year B.Com. and B.Com. Hons. programmes respectively during this week's autumn graduation ceremony. Here are, from the left: Prof. Ronell Britz, Chairperson of the centre, Nils Kotze, first place in the B.Com. third-year group, and Madri Victor, first place in the B.Com. Hons. group; back: Prof. Hentie van Wyk, Programme Director: Accountant Training.
Photo: Stephen Collett

Accounting firms in Free State help with recognition of top achievers
Accounting firms in the Free State have contributed to a fund at the University of the Free State’s (UFS) Centre for Accounting to give recognition to top achievers in the third-year programme for the B.Com. and B.Com Hons. degrees respectively this week. It is evidence of the good relationship that exists between the Centre and the South African Institute for Chartered Accountants (SAICA), Free State. Here, from the left, are: Mr Pieter Clase, CoetzeeSmit Chartered Accountants, Mr Oswald Wentworth, KPMG, Mr Ettienne van Niekerk, PricewaterhouseCoopers, Herman Leach, Gobodo Inc. Chartered Accountants, and Mr Stefan Strydom, Havenga, Rossouw & Viljoen; front: Mr Ian Smit, Enslins Bloemfontein, Ms Thelma Crossman, Mazars, and Ms Daphline O'Brien, Ernst & Young.
Photo: Stephen Collett

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20 April 2009
Faculty of Education, Faculty of the Humanities.

CHESD awards 15 masters degrees
A group of 15 students received the Structured M.A. (Higher Education Studies) of the Centre for Higher Education Studies and Development (CHESD) at this year’s autumn graduation ceremony of the University of the Free State (UFS). This is the biggest group in the centre's history to be awarded master’s degrees, while four of the students received distinctions. Also of interest is that six of the 15 students already have doctoral degrees. At the occasion were, from the left: Dr Dipane Hlalele, Qwaqwa Campus, Ms Liesl Hoare, Central Univeristy of Technology, Welkom Campus (best achiever), and Dr Fanus van Tonder, Programme Director: Higher Education Studies and Research, CHESD. Ms Hoare received the Deans medal in the Faculty of the Humanities as the best master’s graduate student at the graduation ceremony. At the faculty’s prize function she also received the Kovsie-Alumni Trust award as the best M.A student in the faculty. She also received the CHESD Prize for the best achievement in the Structured M.A. (Higher Education Studies).
Photo: Leonie Bolleurs

UFS awards degrees at autumn graduation ceremony
Five hundred and eighty six degrees and nine doctorates were awarded this week during this year's autumn graduation ceremony on the South Campus of the University of the Free State (UFS) to students in the Faculty of the Humanities. At the occasion were, from the left: Nicola Bekker, Madré van der Merwe and Esté Scholtz. All three the ladies received the qualification B.A. Language Practice.
Photo: Lacea Loader

This year’s autumn graduation ceremony of the University of the Free State (UFS) is held on the South Campus in Bloemfontein. Today a group of students from the Programme: Governance and Political Transformation in the Faculty of the Humanities received their qualification. From the left, front are: Dr Tania Coetzee, Head of the Programme: Governance and Political Transformation, and Mr Itumeleng Liba, Chief Operation Officer at CENTLEC; back: Mr Kennett Sinclair, Vice-Chairperson of COPE in the Northern Cape, Ms Nicole Joannou, Goldfields Business and Catering, and Mr Tembeni Lobe from Bloemfontein.
Photo: Lacea Loader

Some of the students who received their qualifications during this week's graduation ceremony of the Faculty of the Humanities were, from the left: Shu-Jung Chan, B.Mus. Hons., Brian Gxavu, B.Mus., and Mpolokeng Lepote, B.A. Media Studies.
Photo: Lacea Loader

UFS’s CHESD awards doctoral degree
Ms Mardi Delport (middle), Assistant Director: Media and Communications at the Central University of Technology received her Doctoral degree at this year’s autumn graduation ceremony of the University of the Free State (UFS). The title of her thesis is: “An internal communication model for the Central University of Technology, Free State as a multi-campus institution”. With her are her promoter Prof. Driekie Hay (left), Vice-Rector: Academic Planning, and her co-promoter, Prof. Annette Wilkinson (right) from the Centre for Higher Education Studies and Development (CHESD) at the UFS.
Photo: Leonie Bolleurs

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