Explainers

Antibiotic Resistance – a Continuing Threat we can no Longer Ignore


Antibiotic resistance is one of the biggest threats to modern healthcare today.

As the number of infections resistant to the use of antibiotics is increasing – affecting anyone of any age and anywhere – there is growing concern about the far reaching implications for everyone around the world.

What is Antibiotic Resistance?

Antibiotic resistance is where the bacteria that causes infection has mutated as a direct response to contact with antibiotics. The bacteria itself becomes antibiotic-resistant – making the infections they cause increasingly harder to treat.

Not only does this lead to increased mortality, prolonged hospital stays and higher medical costs, there is growing concern that antibiotics will eventually become useless at treating infection.

Antimicrobial resistance encompasses resistance to drugs that treat infections caused by other microbes, rather than just bacteria. This can be parasites, viruses, and fungi.

Antimicrobial resistance occurs naturally over time – usually through genetic changes. However, a growing misuse and overuse of antibiotics has accelerated the process dramatically.

As a result, antibiotic resistance is present in every country around the world. There is an increasing drain on healthcare resources being used in an attempt to treat patients infected with resistant strains, and the cost of worsening clinical outcomes is significant.

The Effect of Antibiotic-Resistance on Hospital-Acquired Infection (HAI) is also dramatic.

‘Resistance to first-line drugs to treat infections caused by Staphylococcus aureus—a common cause of severe infections in health facilities and the community—is widespread. People with MRSA (methicillin-resistant Staphylococcus aureus) are estimated to be 64% more likely to die than people with a non-resistant form of the infection.’

(World Health Organisation 2016)

At the start of this year, the first ever list of ‘priority pathogens’ was released by the World Health Organisation. 12 families of bacteria that pose the greatest threat to human health were put on the list, based on:

  • How deadly the infections they cause are,
  • Whether they require long hospital stays,
  • Whether they can be prevented,
  • How many treatment options remain
  • Whether new antibiotics to treat them are already in research and development
  • How frequently they are resistant to existing antibiotics when people in communities catch them
  • How easily they spread through animals, from animals to human, and from person to person

The list highlights the threat of gram-negative bacteria that are resistant to multiple antibiotics, have built-in abilities to resist treatment and can pass along genetic material allowing other bacteria to become drug resistant as well.

As no new class of antibiotic for use against Gram-negative bacteria has been discovered for over 40 years – there is growing concern over how much longer we’ll be able to treat the infections they cause.

According to Dr Marie-Paule Kieny, WHO’s Assistant Director-General for Health Systems and Innovation:

This list is a new tool to ensure R&D responds to urgent public health needs. Antibiotic resistance is growing, and we are fast running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time.’

The list itself is divided into three categories according to the urgency of need – critical, high and medium priority.

The critical groups includes Acinetobacter, Pseudomonas, and various Enterobacteriaceae – multidrug resistant bacteria that pose a particular threat to hospitals, nursing homes, and patients requiring devices such as ventilators and catheters.

So where are we at in terms of research and development today?

There’s a strong focus on developing more and better vaccines to prevent infection occurring in the first place. Cutting down the need for antibiotics is clearly a good direction to take. For example, if every child worldwide received a vaccine protecting them from infection with Streptococcus pneumoniae bacteria (which causes pneumonia, meningitis, and middle ear infections) – this would prevent an estimated 11 million days of antibiotic use each year (WHO 2016).

Other approaches being considered include the use of ‘biological malware’. Better known for infecting computers, researchers are looking into how malware technology can be used to treat humans infected with Mycobacterium tuberculosis.

A prodrug called Ethionamide has no effect until M. tuberculosis takes it up and converts the compound into an active form. This activation occurs through the gene ethA, but has no impact on the infection where there are mutations in the gene.

Scientists have found a normally inactive gene dubbed ‘ethA2’ – so the bacteria hasn’t had a chance to develop resistance to it. The scientists were testing an ethA booster called SMARt-420 and found that it actually increased the ethA2 activity. This in turn made the prodrug ‘ethionamide’ a bacteria killer because the ethA mutation became susceptible to the drug when the ethA2 pathway had been activated.

‘Triggering this secondary pathway is like a biological version of “malware,” says co–senior author Benoit Déprez of the University of Lille in France. In effect, he says, SMARt-420 activates a previously silent system that, when coupled with ethionamide, instructs the bacteria to self-destruct.’

(Hiolski 2017)

Combatting antibiotic-resistance is also down to frontline healthcare workers

There are steps you can take in your day to day nursing practice that can help reduce the spread of infection. Following correct hand washing procedures with every patient is paramount, along with other infection control measures, such as, screening all patients for MRSA on admittance or at pre-op assessment, education of cough and cold ‘etiquette’ for staff, patients, and visitors, and extending universal precautions.

Minimising antibiotic use is essential. It’s recommended that antibiotics are not given until cultures have been confirmed to ensure the correct antibiotic is prescribed, and the patient be reassessed within 48 hours to confirm if antibiotics are still necessary.

Staying aware of antibiotic use and resistance within your hospital or community is also crucial, but so is the correct documentation and record keeping of patient use. A patient receiving a variety of antibiotics over a period of months could indicate potential for resistance in future infections, and all precautions to prevent infection should be taken before that can occur.

Antibiotic resistance is a global problem that is dramatically getting worse, and harder to cope with. As researchers are struggling to find new antibiotics and alternatives quickly enough to counteract the failure of existing medication – infections are proving harder to treat, and have the potential to spiral out of control.

At the moment, there is no end in sight for this crisis so it is important to do what you can within your own practice to reduce risk and control risk. Whilst antibiotics are still essential to treat many infections, and patient demand remains high – controlling use remains one of the few tactics left to combat the problem of antibiotic resistance.

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