How to fight superbugs
In healthcare, superbugs refer to pathogens that are resistant to antibiotics. This makes superbugs a daunting healthcare problem because they threaten lives with simple infections that do not heal.
The global healthcare burden posed by superbugs is known as antimicrobial resistance (AMR), a condition where infectious microorganisms previously susceptible and responsive to a certain treatment become resistant to it.
In a recent healthcare forum, dubbed “Fighting Multi-Drug Resistant Infections” and held at Manila Diamond Hotel, the multi-stakeholder group composed of the Department of Health (DOH), Philippine College of Physicians (PCP), and global healthcare company MSD in the Philippines reiterated its commitment to fight AMR by espousing the country’s Antimicrobial Stewardship Program (ASP) and development of new antibiotics.
Superbug Pseudomonas aeruginosa was the focus of the event discussion as it is highlighted by the World Health Organization (WHO) as critical priority pathogen that is resistant to multiple antibiotics. Pseudomonas infections cause more deaths compared with other pathogens and are highlyresistant to most types of antibiotics like carbapenem which is often referred to as “antibiotic of last resort.” It is the leading cause of pneumonia, the third top cause of urinary tract infections, and eighth leading contributor to bloodstream infections. At risk of Pseudomonas infection are elderly patients, people being treated with antibiotics, diabetics, burn or immunocompromised patients, residents of healthcare facilities, and those with previous histories of infection.
The Philippines, being a country in Southeast Asia, faces more of a threat from carbapanem-resistant Pseudomonas given that the prevalence in the region is from 31 to 50 percent. This number is significantly higher versus the Americas, Europe and Western Pacific, which tallies 16 to 30 percent, based on a WHO report on Prioritization of Pathogens.
The forum saw Dr. Adrian Brink, founding president of the Federation of Infectious Diseases Societies of Southern Africa, discuss Pseudomonas and provide insights on the implementation of ASP in low-resource settings such as South Africa which can possibly be replicated in the Philippines.
Brink described Pseudomonas as “the most sophisticated bug you can find in the hospital. The size of DNA of Pseudomonas is double the size of E. coli,” said Dr. Brink. “The specie has many ways to overcome antibiotics and it can survive most harsh circumstances.”
“If I swab your kitchen or your bathroom or your car, I probably would find Pseudomonas,” added Dr. Brink. “If you flush the toilet, the spray from the toilet water can colonize a patient or, indirectly, through the hands of the doctor or nurse, or equipment like a stethoscope.”
Getting rid of Pseudomonas requires a lot of effort and resources. According to Dr. Brink, one practice is washing of hands before and after touching a patient and when leaving the patient’s room. Many hospitals around the world also use ultraviolet light to decontaminate patients rooms.
Moreover, a novel anti-Pseudomonas cephalosporin, ceftolozane paired with tazobactam is now available as treatment for Pseudomonas infections. The drug was initially indicated for complicated urinary tract and intra-abdominal infections, but had a broader coverage of combating other disease-causing pathogens.
In the fight against AMR and Pseudomonas, the forum highlighted the crucial need to handle antibiotics with care. AMR is largely and often caused by misuse or abuse of anti-microbial drugs as it allows bacteria to develop immunity from antibiotics.
“Every prescription needs to be correct so that every patient is assured they are getting the right antibiotic, right dose, right route of administration, right timing, and right duration. It’s only with this concept that we would be able to optimize patient outcomes, prevent the emergence of AMR, minimize adverse drug reactions, and reduce healthcare costs,” emphasized Dr. Regina Berba, head of the DOH Antimicrobial Stewardship Steering Committee and Chair of the Philippine General Hospital Infection Control Unit.
Dr. Berba explained that the Philippine ASP is led by the DOH in cooperation with other government agencies and strongly supported by health institutions and the private sector.
The ASP involves strong surveillance and laboratory capacity for examining pathogens, access to essential medicines with assured quality, stewardship awareness promotion, and enhanced capability of health institutions in preventing multidrug resistant infections.
“We started AMS training in 2017 and finished it for all level three hospitals. This year, we’re doing more of the level 2 hospitals and next year we hope to finish all 788 level 1 hospitals,” said Berba. “We train about 13 hospitals each time. There are five training hubs right now: PGH, RITM, Corazon Locsin taking care of the Visayas, Southern Philippines Medical Center taking care of the Mindanao group, and recently, we trained Jose B. Lingad Hospital to take care of Central Luzon.”
Members of the private sector also strengthened collaborative efforts with the DOH to fight AMR. Global healthcare company MSD in the Philippines for instance rolled out an eAMS application to 15 government and private hospitals that contained digitized, protocol AMS booklets to bring the advocacy closer to healthcare professionals and to patients.
“Winning against AMR is difficult. We need to preserve our valuable spectrum of antibiotics and develop new drugs that target infections more effectively. We can do this only through integrated efforts between the government and the private sector, doctors and patients,” said Dr. Berba.