Man loses leg to superbug after routine knee operation: Superbug infection should be part of the consent process

A 68-year-old British man has had his right leg amputated in November last year after contracting a superbug infection following what should have been a routine knee replacement. He is one of a growing number of NHS patients for whom common operations are going horribly wrong because of the rise of antibiotic resistance, reported The Telegraph (Jan. 18, 2019). Doctors battled to fight the infection over the course of six years and a series of follow-up operations but without success. His medical notes show a series of infections set in, including the superbugs - methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacter cloacae.  He received a wide range of antibiotics and endured three follow-up knee replacements but the infections could not be killed off. Surgeons even tried an artificial knee coated in silver, a metal known for its anti-bacterial properties. 

The rise in global consumption of antibiotics has led to the emergence of new “superbugs”.

What makes them dangerous is the fact that they are multidrug-resistant. Some examples are: Acinetobacter, pseudomonas, Klebsiella pneumoniae, E.coli, Serratia, Proteus, Mycobacterium abscessus, methicillin resistant Staphylococcus aureus (MRSA) and various enterobacteriaceae.

Superbugs have been reported from all parts of the world, including India. In a recent study reported this month, all oxygen cylinders tested were found to be colonized with the superbug MRSA.

Prima facie, such cases may appear sporadic; but, they are only the tip of the iceberg.

Superbugs have now acquired a global presence and emphasize the need for urgent action to tackle antimicrobial resistance (AMR).

While health care-associated infections should be preventable, the reality is that they are inevitable. Hence, patients should be informed of the chances of infection, including resistant infection/s at the time of admission.

Superbug infection should be part of the consent process, just as antibiotic consent should be a part of the informed consent process so that the patient is aware of the benefits and risks of antibiotics.  

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA