The ‘H-Bug’ epidemic: lessons from antibiotic-resistant staphylococcal outbreaks in New Zealand hospitals from 1955-1963.

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The 'H-Bug' epidemic: lessons from antibiotic-resistant staphylococcal outbreaks in New Zealand hospitals from 1955-1963.

N Z Med J. 2019 Sep 20;132(1502):84-95

Authors: Jowitt D

Abstract
Deadly outbreaks of antibiotic-resistant staphylococcal infection occurred in New Zealand from the mid-1950s to early 1960s. The 'H' or 'Hospital-Bug' epidemic was part of a pandemic wave characterised by high numbers of nosocomial staphylococcal infections and the capacity of Staphylococcus aureus to develop resistance to commonly used antibiotics. Surgical patients and childbearing women and babies proved particularly vulnerable to the predominant pathogenic strain, identified as phage type 80/81. The post-war baby boom was at its height in New Zealand, and overcrowded maternity hospitals and outdated nursing techniques increased the risks of infection. The outbreaks challenged the medical profession, which had become reliant on antibiotics for prophylaxis and treatment. The Health Department ascribed responsibility for the indiscriminate use of antibiotics to medical practitioners but had little control over their prescribing habits. Confronted by increasing infection rates and falling public confidence in the maternity services, health officials supported a fundamental change in maternity care to 'rooming-in' of mother and baby, epidemiological research on staphylococcal transmission in hospitals, notification of nosocomial infections, improved barrier nursing and heightened awareness of appropriate aseptic techniques. Phage type 80/81 waned in the early 1960s concurrent with the arrival of methicillin but the emergence of methicillin-resistant S. aureus (MRSA) in the 1980s, vancomycin-resistant S. aureus (VRSA) in the 2000s, and the rapid emergence and spread of multi-drug resistant Gram-negative bacteria over the past decade, highlights the potential for further outbreaks while the use of antimicrobials remains high. Non-pharmacological interventions such as those promoted during the 'H-Bug' epidemic are likely to be central to controlling future waves of resistant nosocomial infection.

PMID: 31563930 [PubMed - in process]