Kathmandu’s private hospitals fleece Covid-19 patients, multiplying crisis

India facing a pandemic of antibiotics-resistant superbugs

Oct 10: This happens when bacteria change over time and become resistant to drugs that are supposed to defeat them and cure the infections they cause. Such resistance directly caused 1.27 million deaths worldwide in 2019, according to The Lancet, a medical journal. Antibiotics - which are considered to be the first line of defence against severe infections - did not work on most of these cases. India is one of the countries worst hit by what doctors call "antimicrobial resistance" - antibiotic-resistant neonatal infections alone are responsible for the deaths of nearly 60,000 newborns each year. A new government report paints a startling picture of how things are getting worse. Tests carried out at Kasturba Hospital to find out which antibiotic would be be most effective in tackling five main bacterial pathogens have found that a number of key drugs were barely effective. These pathogens include E.coli (Escherichia coli), commonly found in the intestines of humans and animals after consumption of contaminated food; Klebsiella pneumoniae, which can infect the lungs to cause pneumonia, and the blood, cuts in the skin and the lining of the brain to cause meningitis; and the deadly Staphylococcus aureus, a food-borne bacteria that can be transmitted through air droplets or aerosols. Doctors found that some of the main antibiotics were less than 15% effective in treating infections caused by these pathogens. Most concerning was the emergence of the multidrug-resistant pathogen called Acinetobacter baumannii, which attacks the lungs of patients on life support in critical care units. "As almost all our patients cannot afford the higher antibiotics, they run the real risk of dying when they develop ventilator-associated pneumonia in the ICU," Dr SP Kalantri, medical superintendent of the hospital, says. A new report by Indian Council of Medical Research (ICMR) says that resistance to a powerful class of antibiotics called carbapenems - it defeats a number of pathogens - had risen by up to 10% in just one year alone. The report collects data on antibiotic resistance from up to 30 public and private hospitals every year. "The reason why this is alarming is that it is a great drug to treat sepsis [a life-threatening condition] and sometimes used as a first line of treatment in hospitals for very sick patients in ICUs," says Dr Kamini Walia, a scientist at Indian Council of Medical Research (ICMR) and lead author of the study. Things are so worrying that only 43% of the pneumonia infections caused by one pathogen in India could be treated with first line of antibiotics in 2021, down from 65% in 2016, the ICMR report says. Saswati Sinha, a critical care specialist in AMRI Hospital in the eastern city of Kolkata, says things are so bad that "six out of 10" patients in her ICU have drug-resistant infections. "The situation is truly alarming. We have come to a stage where you are not left with too many options to treat some of these patients." Resistance to antibiotics, say doctors at Kasturba Hospital, is widespread even among outpatients from villages and small towns with conditions such as pneumonia and urinary tract infections. Since most don't carry prescriptions and can't recall the drugs they were prescribed, doctors find it difficult to get records of their past exposure to antibiotics. Managing such patients is an ordeal. "The situation is desperate, and desperate measures - ordering more and more antibiotics is likely to result in more harm than benefits," says Dr Kalantri. Public health experts believe many doctors in India prescribe antibiotics indiscriminately. Antibiotics, for example, cannot cure viral illnesses like flu or common cold. Patients with dengue - a viral infection - and malaria - caused by a single-celled parasite - often receive antibiotics. Antibiotics continue to be prescribed for diarrheal diseases and upper respiratory infections for which they have limited value. During the chaotic treatment of Covid-19, patients were treated with antibiotics which resulted in more adverse effects. Last year, a ICMR study of 17,534 Covid-19 patients in Indian hospitals found that more than half of them who acquired drug-resistant infections died. Yet prescriptions for broad-spectrum antibiotics - drugs that should be reserved for tackling the most serious, hard-to-treat bacterial infections - comprise a whopping 75% of all prescriptions issued in India's hospitals, studies have found. To be true, doctors are not to blame entirely. In large, crowded public hospitals, they are starved of time of see patients, diagnose their illnesses, sort bacterial from viral diseases and design treatment plans, says Dr Kalantri. A widespread lack of knowledge about antibiotics means that most patients - rural and urban - are not aware of antibiotic resistance. Even the rich and educated take antibiotics if they fall ill or pressure doctors to prescribe antibiotics. As prices of antibiotics fall and diagnostics remain expensive, doctors prefer to prescribe drugs rather than order tests. "Doctors are sometimes not sure what they are treating, and they want to treat everything by using broad-spectrum drugs," says Dr Walia. Hospital infections are also to blame. Patients are often pumped with antibiotics to compensate for poor hygiene and sanitation, "because no doctor wants to lose a patient because of an infection". "It is a perfect storm as far as India goes. There are lots of infectious diseases in the background, lack of infection control and a lot of unnecessary consumption of antibiotics," Ramanan Laxminarayan, director of the One Health Trust, a global public health think tank, says. Experts believe India needs to invest more in and beef up diagnostic labs, produce more infectious diseases physicians, reduce hospital infections and train doctors on usage of antibiotics based on tests to tackle the rising threat of superbugs. Otherwise, "resistance to antibiotics has the potential of taking the form of a pandemic in near future," warns Dr Walia.

Ratopati English भाद्र २०७९

Nepal’s market monitors underperform as they are under political pressure, understaffed and ill-equipped

Onlinekhabar English श्रावण २०७८

Covid-19 Nepal: Some hospitals charging patients despite reimbursements from govt

Onlinekhabar English जेष्ठ २०७८

Bed shortage at public hospitals pushing Covid-19 patients to expensive private hospitals

The Kathmandu Post बैशाख २०७८

Hospitals in Bhaktapur grappling without oxygen

BHAKTAPUR, May 12: Various hospitals in Bhaktapur district are struggling to save lives of Covid-19 patients without oxygen. In many cases, Covid-19 patients need oxygen support in treatment process. Many hospitals in the district have been flooded with the patients following the second wave of the infection. Without oxygen, many hospitals have refused to admit coronavirus patients. Bhaktapur Hospital is struggling without oxygen since Thursday night. The supply is yet to be made despite informing about the matter to the Covid-19 Crisis Management Centre (CCMC), the Ministry of Health and the respective province ministry, said the hospital medical superintendent Dr Sumitra Gautam. Sagarmatha Oxygen Company had been supplying oxygen to the hospital. The hospital got the supply from Janakpur after the Company lacks oxygen. But there is a scarcity of oxygen in Janakpur too and it takes at least two days for the supply to arrive here, thus making the matter worse, said Gautam. Negligence is the CCMC is to blame for the situation. The CCMC has removed the hospital from the recommendation list for oxygen citing the hospital is provincial level, thus creating the problem, said the hospital administration. At present, the hospital is providing treatment to 70 Covid-19 patients. It has consumed 200 oxygen cylinders in 24 hours as all coronavirus patients need oxygen support, said Gautam. “We started receiving the supply from Janakpur after the Kathmandu Valley lacks oxygen. However, there is also a lack of oxygen in Janakpur too. The government has asked hospital to run a 70-bed high care unit for coronavirus patients. But there is a lack of oxygen. How can we admit new patients in such situation?.” “The hospital lacks oxygen. All patients need oxygen support. Lives of patients are at risk. The hospital cannot take responsibility in case of any untoward incident.” The provision that the CCMC’s recommendation is needed for oxygen has added to the problem of the hospital, she said. Nepal-Korea Friendship Municipality Hospital run by Madyapurthimi Municipality also lacks oxygen. The hospital has used 70 oxygen cylinders on a daily basis. However, the CCMC has recommended a Kavrepalanchok-based oxygen plant to provide only 10 cylinders to the hospital, thus making the matter worse, said the municipality mayor Madan Sundar Shrestha. The hospital has six ventilators, five intensive care units, 14 high care units and 18 emergency units. The hospital’s situation reached the stage that mayor Shrestha on Tuesday stepped in to collect oxygen cylinders to save lives of 18 coronavirus patients. He managed the oxygen cylinders from the oxygen plant in Kavrepalanchok after his calls to the CCMC, the Health Ministry, Teku Hospital and various oxygen companies for the same went in vain, said Shrestha. “Fifteen more beds have been added to the hospital following increasing flow of Covid-19 patients. However, these beds have yet to come into operation without oxygen. There is not a situation wherein to admit new patients,” he said. To ease the matter, the hospital would soon set up an oxygen plant, he said. Bhaktapur Hospital is struggling without oxygen and many private hospitals are on the verge of a closure as a result, said Krishna Prasad Mijar, chief of the health office, Bhaktapur. Teaching Hospital in Kathmandu lacks oxygen risking patients’ lives, said Manohar Shrestha, relative of a patient admitted to the hospital. “Doctors at the hospital burst into tears telling that the hospital lacks oxygen. So it is difficult to save lives of patients. We cannot admit new patients in such situation,” he said quoting doctors. The Kathmandu Valley has needed 15,000 liters oxygen on a daily basis against the supply of only 7,000 liters, according to available data. Some days ago, two Covid-19 patients died at Bhaktapur International Hospital apparently due to lack of oxygen. As a result, the hospital and other Madyapur Hospital, Nagarik Community Hospital, Summit Hospital, Dr Iwamura Memorial Hospital and Siddhi Memorial Hospital have decided not to admit coronavirus patients.

Ratopati English चैत्र २०७७

Private hospitals charging high will face action: DPM Pokharel

KATHMANDU, May 6: Deputy Prime Minister Ishwar Pokharel has said the private hospitals charging higher to the coronavirus-infected patients will face action. “Private hospitals should provide treatment to patients at the government-determined costs. Those charging higher are subject to action. The District Administration Office, Kathmandu has also warned action following complaints on the acts of health facilities arbitrarily charging patients with exorbitant prices to”, he said while talking to media-persons at his office in Singha Durbar on Thursday. Covid-19 patients are receiving free of cost treatment at government hospitals.

Ratopati English चैत्र २०७७

Covid-19 patients from low and middle income can’t afford beds in private hospitals

The Kathmandu Post चैत्र २०७७

Covid-19 patients from low and middle income can’t afford beds in private hospitals

The Kathmandu Post चैत्र २०७७

Covid-19 patients from low and middle income can’t afford beds in private hospitals

The Kathmandu Post चैत्र २०७७

DPM Pokharel takes stock of Covid-19 situation in Banke, directs measures to save people's lives

Ratopati English चैत्र २०७७

Kathmandu’s private hospitals fleece Covid-19 patients, multiplying crisis

सम्बन्धित सामग्री