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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

Studies to reveal correlation between terrain, energy use, and giraffe locomotion

2016-11-18

More than half of giraffes in captivity in Europe are afflicted by lameness. This high prevalence represents an important welfare issue, similar to other large zoo animals.

According to Dr Chris Basu, a veterinarian at the Royal Veterinary College in the UK, giraffes in captivity are often afflicted by overgrown hooves, laminitis and joint problems. Diagnosis and treatment is limited by our understanding of anatomy and function, more specifically the locomotion of these animals. Although the giraffe is such a well-known and iconic animal, relatively little has been studied about their locomotor behaviour.

Dr Basu recently visited South Africa to do fieldwork on the locomotion of giraffes as part of his PhD studies under the mentorship of world-renowned Professor of Evolutionary Biomechanics, Prof John Hutchinson. This project is a joint venture between Dr Basu and Dr Francois Deacon, researcher in the Department of Animal, Wildlife, and Grassland Sciences at the UFS. Dr Deacon is a specialist in giraffe habitat-related research.

Together Prof Hutchinson and Drs Deacon and Basu form a research group, working on studies about giraffe locomotion.

Wild giraffe population decrease by 40% in past decade

“Locomotion is one of the most common animal behaviours and comes with a significant daily energetic cost. Studying locomotion of wild animals aids us in making estimates of this energetic cost. Such estimates are useful in understanding how giraffes fit into ecosystems. Future conservation efforts will be influenced by knowledge of the energy demands in giraffes.

“Understanding aspects of giraffe locomotion also helps us to understand the relationships between anatomy, function and evolution. This is relevant to our basic understanding of the natural world, as well as to conservation and veterinary issues,” said Dr Deacon.

Locomotion study brings strategy for specialist foot care

On face value it seems as if foot disease pathologies are more common in zoo giraffes than in wild giraffes. “However, we need a good sample of data from both populations to prove this assumption,” said Dr Basu.

This phenomenon is not well understood at the moment, but it’s thought that diet, substrate (e.g. concrete, straw, sand and grass) and genetics play a part in foot disease in giraffes. “Understanding how the feet are mechanically loaded during common activities (standing, walking, running) gives our research group ideas of where the highest strains occur, and later how these can be reduced through corrective foot trimming,” said Dr Basu.

Through the studies on giraffe locomotion, the research group plans to devise strategies for corrective foot trimming. At the moment, foot trimming is done with the best evidence available, which is extrapolation from closely related animals such as cattle. “But we know that giraffes’ specialist anatomy will likely demand specialist foot care,” Dr Basu said.

Studying giraffes in smaller versus larger spaces

The research group has begun to study the biomechanics of giraffe walking by looking at the kinematics (the movement) and the kinetics (the forces involved in movement) during walking strides. For this he studied adult giraffes at three zoological parks in the UK.

However, due to the close proximity of fencing and buildings, it is not practical to study fast speeds in a zoo setting.

A setting such as the Willem Pretorius Nature Reserve, near Ventersburg in the Free State, Kwaggafontein Nature Reserve, near Colesberg in the Karoo, and the Woodland Hills Wildlife Estate in Bloemfontein are all ideal for studying crucial aspects such as “faster than walking” speeds and gaits to measure key parameters (such as stride length, step frequency and stride duration). These studies are important to understand how giraffe form and function are adapted to their full range of locomotor behaviours. It also helps to comprehend the limits on athletic capacity in giraffes and how these compare to other animals.

Drones open up unique opportunities for studying giraffes

The increasing availability of unmanned aerial vehicles (UAVs)/drones opens up unique opportunities for studying locomotion in animals like giraffes. Cameras mounted onto remotely controlled UAVs are a straightforward way to obtain high-quality video footage of giraffes while they run at different speeds.

“Using two UAVs, we have collected high definition slow motion video footage of galloping giraffes from three locations in the Free State. We have also collected detailed information about the terrain that the giraffes walked and ran across. From this we have created 3D maps of the ground. These maps will be used to examine the preferred terrain types for giraffes, and to see how different terrains affect their locomotion and energy use,” said Dr Deacon.

“The raw data (videos) will be digitised to obtain the stride parameters and limb angles of the animals. Later this will be combined with anatomical data and an estimation of limb forces to estimate the power output of the limbs and how that changes between different terrains,” said Dr Basu.

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