Anti-microbial resistance poses public health threat

AS THE world steers towards recovery, the effects of yet another ongoing global challenge is rearing its head, as the South African health system grapples with anti-microbial resistance (AMR).

A paper published on Anti-microbial Stewardship in Public Sector Hospitals in KwaZulu-Natal, indicated a shortage of infectious diseases physicians practising countrywide as AMR continues to pose a public health threat.

According to the report, the loss of effective antibiotics threatened the outcome of modern-day surgery, cancer chemotherapy, organ transplant and the treatment of infectious diseases. The report further explained that resistance also impacted the local and global economy as the treatment of infections caused by multi-drug resistant (MDR) bacteria required longer and more expensive therapeutic regimens.

In the report, lecturer in pharmacology at the University of the Witwatersrand and lead author, Dr Sarentha Chetty, said only three of 57 health facilities in KZN set aside money for teams to roll out South Africa’s official plan for curbing AMR, and just four out of 10 hospitals in the province had a microbiologist on their team and only two had an on-site infectious diseases specialist.

“Appointing a pharmacist as a co-leader is often recommended, as this provides drug expertise for the anti-microbial stewardship. Clinical microbiologists are integral to the success of stewardship. They provide essential diagnostic services, information on biomarkers, rapid diagnostics, anti-microbial susceptibility testing, the testing of new drugs against appropriate pathogens, surveillance, cumulative antimicrobial susceptibility reports (antibiograms), and the provision of education,” said Chetty.

In the Western Cape, head of South Africa’s ministerial advisory committee on AMR, Marc Mendelson, said that over the past year four patients in Groote Schuur Hospital had to have a leg amputated after a knee operation went wrong because of an infection for which antibiotics no longer worked.

“We look after an increasing number of patients who acquire common (urinary, bloodstream, joint, lung etc) infections that are either resistant to all known and available antibiotics in South Africa, or require the last-resort antibiotic that we have. This includes for example, patients whose joint replacements have become infected, occasionally requiring amputation to control the infection as no antibiotic remains to use; patients with bloodstream infections requiring last resort antibiotics that are not optimal for treatment of their infection and thus die of the infection; and patients with complicated urinary tract infections which also are untreatable.

“Although the majority of infections we see remain treatable, increasing resistance of bacteria to antibiotics is affecting treatment and prevention of common infections.

“Patients may die, but many more suffer long-term complications from incompletely treated infections, requiring longer stays in hospitals and longterm effects.

Mendelson said that increasing antibiotic resistance affected everyone and not just those taking antibiotics.

“Like climate change, antibiotics are global common goods i.e. the users carry a shared responsibility. When you fill your car with petrol and contribute to the greenhouse gases, you are not only affecting your health and future, but everyone else’s on the planet.

“Similarly, because antibiotic resistant bacteria can be transmitted from person to person, if you take an antibiotic unnecessarily and help antibiotic resistant bacteria increase in and on your body, those resistant bacteria can be transferred to your family, friends, and community. The net result is that you are affecting others. If they develop an infection with those bacteria, their chances of cure and survival are diminished. This is not something that you can shy away from or absolve yourself of responsibility. We all have a role in this,” said Mendelson.

He said the first solution was to prevent an infection which would prevent the need for an antibiotic.

With the increasing use of antibiotics, principal pathologist at the National Institute for Communicable Diseases, Professor Olga Perovic, said the solution to the problem of antibiotic resistance was a multi-faceted problem that had many moving parts.

“There is no one solution to fit all. As antibiotics and antimicrobials resistance was evident and recorded in the 1950s and still carried up to the current moment, complexity and approach that requires many programmes to puzzle in one was very difficult. AMR involves human, animal and environmental niches and the need for integration is evident,” said Perovic.