The figures speak of 3,000 deaths from traffic accidents and as many as 8,000 deaths from hospital infections. Increasing or decreasing statistics?

The news reports each year remind us that road traffic deaths are increasing or decreasing. This news is striking because everyone is on the road by various means every day. However, against the little more than 3,000 deaths that occur due to road accidents each year, there are more than 8,000 people in Italy who lose their lives due to a hospital infection; even some statistics report 10,000 deaths — we’ll see later the reason for this discrepancy.

Should we begin by asking ourselves why this is happening? It’s quite intuitive that in a place like the hospital (where so many people with various pathologies are concentrated), so-called communicable diseases, that is, infections by microorganisms can spread from the sick-to-sick.

Let’s consider some estimates taken from Epicentre, the Epidemiology Portal for Public Health.

5% of hospitalized patients contract an infection during hospitalization. This is a figure that doesn’t take into account infections contracted during a “simple” visit to the ER, especially during the peak Winter months of infectious diseases, such as influenza.

5% may seem like a small number, but if we consider the number of people who are hospitalized each year, that percentage blossoms into a medium-to-large city like Genoa or Palermo (i.e. 450,000-to-700,000 patients who, each year after hospitalization, show an infection they didn’t previously have; mostly urinary tract infections, surgical wound infections, pneumonia and sepsis. Of these, it’s estimated that about 30% (or 135,000-to-210,000) are potentially preventable, and directly cause the death of 1% of cases; so that between 1,350 and 2,100 deaths per year could be completely avoided.

Another important aspect of hospital or nosocomial infections is the so-called antibiotic resistance. One-third of all hospital-acquired infections in Italy have some resistance to antibiotics. If we compare it with the rest of Europe, where each year about 33,000 patients die from infections caused by antibiotic-resistant microorganisms, Italy has the sad honor of being the nation, together with Greece, at the top of the table.

Why are microorganisms becoming resistant to antibiotics?

It’s a simple adaptation and evolutionary defense mechanism of the species, which Charles Darwin described very well, over a century-and-a-half ago about animals, and which also adapts well to microorganisms. To put it simply, we can say that if even a single bacterium has a mutation that makes it antibiotic-resistant, this bacterium will not die and can reproduce without being disturbed.

The bacteria multiply every twenty minutes, so with a simple calculation you can easily imagine how, from a single bacterium, in 12 hours the organism would be invaded by more than half-a-billion bacteria of the same species. In addition, in the case of resistance to a specific class of antibiotics, there are not many alternatives, as in the case of carbapenemas that belong to the family of beta-lactam antibiotics.

Carbapenemas are often used in hospitals as a last-line drug, especially on patients infected with MDR (Multi-Drug-Resistant) bacteria. The most commonly used carbapenems are Thienamycin, Imipenem, and Meropenem. There is now an increase in the resistance of bacteria to this class of antibiotics as well, and this is a cause for concern because, as previously mentioned, these are antibiotics of “last resort”.

What could be a future scenario?

It’s certainly necessary to develop an efficient system for the detection of hospital infections. We mentioned at the beginning of this article that the estimates in Italy for death due to hospital infections are 8,000 but other statistics indicate 10,000; too much of a discrepancy for a serious deep-dive into the data.

The application of good practices that are already known but scarcely used (i.e. the correct washing of the hands of operators and relatives, the control of environmental cleanliness, the vaccination of health workers — primarily against influenza).

The correct use of antibiotics, starting with the prescription by general practitioners, sometimes too favorable to “please” the patient, up to the choice of the type of antibiotic that passes through a more precise diagnosis — even before arriving at the hospital.

The trend already underway in hospitals is to curtail the hospital stay and increase the day-stay in hospital. This is one of the solutions to reduce the probability of contracting a hospital infection; especially for older patients who are at greater risk.

Jokingly, but not too much; for the elderly, children and immunodepressed people, it’s more dangerous to stay in hospital than to be on a long drive on the highway. Therefore, let’s protect the weakest by putting in place all the prevention mechanisms we know of, and rely on the experts.

This post is also available in: Italiano

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