Antibiotic Resistance: A Continuing Threat we can no Longer Ignore
Published: 01 June 2017
Published: 01 June 2017
As the number of infections resistant to antibiotics increases, there is growing concern about the far-reaching implications for everyone around the world (WHO 2020a).
Antibiotic resistance is when bacteria that cause an infection mutate as a direct response to contact with antibiotics. The bacteria themselves become antibiotic-resistant, making the infections they cause increasingly harder to treat (WHO 2020a).
Not only does this lead to increased mortality, prolonged hospital stays and higher medical costs, but there are also growing concerns that antibiotics will eventually become useless at treating infection (WHO 2020a).
The broader term antimicrobial resistance includes other pathogens that may develop a resistance to medications (viruses, parasites and fungi), in addition to bacteria (WHO 2020b).
Antimicrobial resistance occurs naturally over time, usually through genetic changes. However, a growing misuse and overuse of antibiotics is accelerating this process dramatically (WHO 2020b).
As a result, antibiotic resistance is present in every country around the world. There is increasing pressure on healthcare resources being used in an attempt to treat patients infected with resistant strains, and the cost of worsening clinical outcomes is significant (WHO 2020b).
‘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.’
In 2017, the World Health Organisation published the first ever list of ‘priority pathogens’. 12 families of bacteria that pose the greatest threat to human health were listed, based on:
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 resistant as well.
As no new class of antibiotics 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 (Buckland 2017).
The WHO’s list is divided into three categories according to the urgency of need: critical, high and medium priority.
The critical group 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 (WHO 2017).
There is a strong focus on developing more and better vaccines to prevent infections from occurring in the first place and reduce the need for antibiotics overall. For example, according to the WHO (2016), if every child worldwide was vaccinated against infection from Streptococcus pneumoniae bacteria, 11 million days of antibiotic use would be prevented each year.
Other approaches being considered include the use of ‘biological malware’, which could be used to treat people infected with Mycobacterium tuberculosis (Hiolski 2017).
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 (Hiolski 2017).
Scientists have found a gene dubbed ‘ethA2’ that is normally inactive - meaning the M. tuberculosis bacteria hasn’t had a chance to develop resistance to it. When testing an ethA booster called SMARt-420, they found that it actually increased 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 (Hiolski 2017).
There are steps you can take in your day to day nursing practice to help reduce the spread of infection. Following correct hand hygiene procedures with every patient is paramount, along with other infection control measures such as screening all patients for Methicillin-resistant Staphylococcus aureus (MRSA) on admittance or at pre-op assessment, cough and cold etiquette education for staff, patients, and visitors, and extending universal precautions.
Minimising antibiotic use is essential. Always ensure antibiotics are only prescribed when needed, and check that the treatment length and dosage are correct (AMR 2017).
Refer to the Therapeutic Guidelines, which are based on the best available evidence and opinion in Australia.
Staying aware of antibiotic use and resistance within your hospital or community is crucial, along with correct documentation and record-keeping of any patient use.
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 medications, infections are proving harder to treat, and have the potential to eventually spiral out of control.
It is crucial to do what you can within your own practice to reduce and control the risk of antibiotic resistance. While antibiotics are still essential for treating many infections, and patient demand remains high, controlling their use remains one of the few tactics left to combat this growing issue.