Medics: Awareness crucial to arrest needless deaths

- Manish Gautam, Kathmandu

Sep 13, 2014-

Twenty-five-year-old Nishan Pathak from Nawalparasi died the next day he was brought to Kathmandu in Tribhuvan University Teaching Hospital (TUTH) in August last month. The trouble began when he suffered from high-fever and started taking an antibiotic dispensed by the local pharmacy in the area. As his fever persisted for the next one week he was taken to Chitwan Medical College before being shifted to Kathmandu. While undergoing treatment at TUTH, his blood pressure dipped and blood tests revealed his kidney function decreased and liver too was abnormal.

Doctors attending Pathak assessed that he had developed infection after being administered antibiotics for typhoid. The antibiotic (Ciprofloxacin 500) had been overused and developed resistance without conducting any blood tests or other diagnosis. “If this patient was referred to a doctor or hospital and a chest x-ray was done, pneumonia could have been picked in early stage. But the pneumonia infected blood and then all over the body leading to his death,” said Dr Subash Acharya, chief of medical ICU at TUTH. Similarly, three weeks ago a 62-year-old patient underwent a by-pass surgery in Manmohan Cardiothoracic Vascular and Transplant Center. The surgery was successful but after spending four days at post-operative ward “he started coughing and his x ray showed atelectasis, collapse of an expanded lung. His blood culture test returned a few isolates of severe drug resistant gram negative bacteria, which doctors believed, was probably acquired during his stay in the hospital. The patient died the next day because of multiple organ failure, despite the fact that his graft that was kept on the heart was functioning normally. Sepsis, experts say, is a leading cause of death in Nepal but there has not been systematic study on the issue. Sepsis is a condition when infections in any part enters the blood stream and seriously disturbs the bodily functions. If sepsis is not treated in time, it leads to septic shock and also multiple organ failure, resulting in death of the patients.

Government and independent research in Nepal has so far focused on the deaths of new born due to sepsis in the first week or two of life. It remains a major killer of newborn arising from infection of the umbilical cord.

In the lack of national data, individual analyses of ICU of some hospitals paint an appalling picture of sepsis. In 2013, among 550 patients treated in ICU of TUTH, 193 died due to sepsis, which accounted for 35 percent of total deaths.

According to the Centre for Disease Control and Prevention, sepsis remains a leading cause of death in America and on average 4,600 new patients are treated daily for this condition in US hospitals. Dr Acharya said hospital remains a major source for sepsis as health professionals does not adhere to simple measures such as hand washing. The poor hygiene in hospitals and operating theatres was revealed after a woman died in Prasuti Griha in September 2012. Doctors at Prasuti Griha suspected a possible “infection” in the OTs following Caesarian sections on September 14 and had shut down the service to disinfect the rooms.

On Friday, a patient of multi-drug resistance tuberculosis was referred from B&B Hospital, Gwarko citing unavailability of ventilator—an artificial breathing machine-to Chirayu Hospital in Basundhara. The ambulance, which transported the patient, had no bottled oxygen. Doctors struggled for almost two hours but could not save the patient. The doctors pointed to sepsis as the cause of death.

Dr Arjun Karki, a specialist on critical care medicine, said in Nepal sepsis occurs mainly due to infection, arbitrary use of antibiotics, inadequate and improper hygiene in health setup and ineffectiveness of health system.

“The government has to come up with a stricter policy on the dispensing of antibiotics, making a doctor’s prescription must,” said Dr Karki.

Published: 14-09-2014 09:17

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