World alert on antibiotics

Patients could run out of options

PATIENTS with infections could soon run out of treatment options if the injudicious use of antibiotics is not stopped immediately.

The World Health Organization (WHO) yesterday released a grim report in which it noted high levels of resistance in bacteria which cause life-threatening bloodstream infections, as well as increasing resistance to treatment in several bacteria that cause more common infections.

The report was based on data collected from 87 countries.

“Antimicrobial resistance (AMR) undermines modern medicine and puts millions of lives at risk,” said WHO director-general Tedros Adhanom Ghebreyesus.

“To truly understand the extent of the global threat and mount an effective public health response to AMR, we must scale up microbiology testing and provide quality-assured data across all countries, not just wealthier ones,” he said.

The WHO said that the Global Antimicrobial Resistance and Use Surveillance System (Glass) report provided analyses for AMR rates in the context of national testing coverage, AMR trends since 2017, and data on antimicrobial consumption in humans in 27 countries.

According to the Glass report, high levels (above 50%) of resistance were reported in bacteria frequently causing bloodstream infections in hospitals, such as Klebsiella pneumoniae and Acinetobacter spp.

It said these life-threatening infections required treatment with last-resort antibiotics, such as carbapenems. However, 8% of bloodstream infections caused by Klebsiella pneumoniae were reported as resistant to carbapenems, increasing the risk of death because of unmanageable infections.

The WHO report said common bacterial infections were becoming increasingly resistant to treatments.

More than 60% of Neisseria gonorrhoea isolates, a common sexually transmitted disease, have shown resistance to one of the most used oral antibacterials, ciprofloxacin.

At least 20% of E.coli isolates – the most common pathogen in urinary tract infections – were resistant to first-line drugs (ampicillin and co-trimoxazole) and second-line treatments (fluoroquinolones).

Senior lecturer of pharmacology at the University of KwaZulu-Natal Andy Gray, said like many other countries, South Africa struggled with increasing resistance, not just related to bacteria, but fungi and viruses as well.

Gray said major areas of concern were in the bacteria that caused hospital infections where there was increasing resistance to the antibiotics that were available and an increasing need to use last-resort antibiotics.

Gray said gram negative bacteria that caused pneumonia, meningitis and septicaemia (blood infections) were among the ones that were a problem.

“They are a problem across all of our hospitals in the private and public sector and they are the direct result of inappropriate use of antibiotics, inappropriate prescribing but also inappropriate prevention of infections, infection control measures and in some cases vaccination.”

He said the second area of concern for South Africa was tuberculosis because of the high burden and as one of the countries heavily affected by drug-resistant TB.

However, there was some “resistance status, and there were reports from the National Health Laboratory Service and private labs report on resistance, but the data on the consumption of antimicrobials, how much was being used, how much was being prescribed, as well as where and for what reasons, was terrible”.

While South Africa had reported on the Glass antimicrobial data, there was a big hole in the antimicrobial stewardship programme “We should be using antibiotics when we have to – they’re absolutely crucial to dealing with established infection – but we’ve got to use the right antibiotic for the right reason at the right dose for the right duration of time. Inappropriate prescribing is what drives increasing resistance,” said Gray.

He said there was evidence that patients were able to access antibiotics without a prescription and there was definitely overuse of antibiotics, for instance where there was a viral infection and an antibiotic was prescribed even when it was “going to do absolutely nothing”.

Health Department spokesperson Foster Mohale said South Africa had submitted data to the WHO Glass system since its induction.

He said this year, South Africa was applying to submit national antimicrobial procurement to the Glass system as well, although this data was not yet available on the WHO website.

However, Mohale said in the Surveillance for AMR and Consumption of Antimicrobials in South Africa, 2021, there was data on the resistance patterns in human and animal health-care sectors as well as the procurement of antimicrobials in both sectors.

“Unless humans can ensure the prudent use of antimicrobials in humans and animals, and protect the environment from antibiotic by-product, antimicrobial resistance will, and should, increasingly be of the utmost concern to all,” Mohale concluded.

Gray said there was a “real problem” in private hospitals where the doctors were not employed by the hospital. Instead they were solo practitioners and had the right to admit patients to the hospital. Because of this, private hospitals struggled to intervene to improve the quality of the use of antibiotics.

“In our public sectors we have large numbers of prescribers, including primary health-care nurses … who suspect something, they are not doing a culture and on the basis of the patient presentation they decide to use an antibiotic and we see over usage of some of those antibiotics.

“Many of them becoming increasingly useless as resistance increases across the country.”