KPC deaths draw U.S. attention

Panama's CSS hospital may be leading the world in the number of KPC deaths according to an extensive report in a leading U.S. on-line publication. 

A recent study by a Latin American  medical investigation  team indicated that the problem is here to stay.

This is the report by Joe Shea

BRADENTON, Fla., Aug. 25, 2011 — Hospital-acquired infections of a dangerous multiple drug-resistant bacteria called KPC has claimed more than 50 lives at the largest public hospital in Panama, The American Reporter has learned.

The so-called “nosocomial” infections have prompted two of the Central American gateway nation's largest medical associations to briefly suspend the treatment of patients at the vast, 1,321-bed Arnulfo Arias Madrid Hospital in Panama City, and a hospital physician has charged its director with "wrongful death" for not doing more to control the infections when informed about them.

According to a trusted source in Panama, the infections are the result of substandard conditions at the Metropolitan Hospital Complex, including a lack of hygiene and overcrowding at the hospital, which serves hundreds of thousands of the poorest Panamanians each year.

The number of patients seeking care at Arnulfo Arias Madrid Hospital has dropped dramatically, according to Guillermo Saez-Llorens of Panama's Social Security Fund, the hospital’s director. The number of outpatient visits at the hospital's clinic has also fallen sharply, he said Monday.

There has also been a reduction in emergency room care, said Robert Mitre, the hospital – run by the country's social security fund – said Monday. Those who do get treated are more likely to be suffering from "true emergencies," he said.

Although the death toll has risen sharply and may represent a worst-case scenario among public hospitals throughout the world, the major epidemiological alert publication, ProMEDmail.org, has ignored the death toll in Panama while reporting far less serious issues around the world.

The editors of Harvard University-based ProMEDmail did not respond to email sent Tuesday seeking comment.

On Aug. 16, the leader of the National Negotiating Medical Commission (Comenenal), Fernando Castañeda, said the National Federation of Internal Physicians and the hospital-based Assn. of Resident Internal Doctors announced the physicians would begin a 24-hour work stoppage to protest the conditions and the apparent indifference of the hospital's overseers, the Board of Directors of the Social Security Fund.

"Panama's health care cannot continue as it is now,” he said on RPC Radio at the time.

Earlier, after a string of cases dating back to August of 2010, a surgeon at the hospital section filed charges against Sáez-Llorens, the hospital's director, claiming he had ignored 71 instances of the infections. The complaint against Sáez-Llorens of causing wrongful death by negligence was filed Aug. 16.

Dr. Mauro Zúñiga told Panamanian daily newspaper La Prensa that he filed the complaint because Sáez-Llorens had been aware since August 2010 of KPC’s presence and that at least 16 people had died.

The bacteria are hard to identify by standard testing and can leave few options for treatment, the medical journal Lancet said in an August 2009 article. "Carbapenems (imipenem, meropenem, and ertapenem) may thus become inefficient for treating enterobacterial infections with KPC-producing bacteria, which are, in addition, resistant to many other beta-lactam[antibiotics that work by inhibiting bacterial cell wall synthesis] molecules, leaving few available therapeutic options. Detection of KPC-producing bacteria may be difficult based on routine antibiotic susceptibility testing. It is therefore crucial to implement efficient infection control measures to limit the spread of these pathogens."

According to the complaint, Sáez-Llorens did not take the necessary measures after being informed of the problem. The complaint was filed in the Attorney General's Office, and Zuniga requested an appointment with Attorney General Ayú Jose Prado to discuss it.

Newsroom Panama reported that "a retrospective study confirmed the presence of the anti-biotic resistant pathogen Klebsiella pneumoniae resistant carbapenemase (KPC) in 71 patients" at the hospital. The number refers to people who may be infected or colonized with the KPC and follows a study of records over the past year. The last death toll reported was 16, according to Felix Bonilla, secretary general of the Ministry of Health (MoH).

Hospital authorities have asked the public to go to the hospital only when absolutely necessary and stress that children and senior citizens should avoid visiting the center, Newsroom Panama said.