Bacteria resistant to antibiotics are reaching epidemic proportions around the world, particularly in developing counties. In Australia, we're also seeing increasing numbers of serious infections which are very difficult or impossible to treat. This is because the bacteria causing these infections are resistant to most -- and sometimes all -- antibiotics. These strains of bacteria are known as superbugs.
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Superbugs are able to resist the effects of the antibiotics we direct against them. They have effectively put on bullet-proof vests against our "magic bullets" (antibiotics) that cured people with serious infections. They do this by destroying the drug or altering the "goal posts", by changing the receptors where these drugs need to bind and act.
When serious infections can't be treated with common antibiotics, the risk of complications and death increases exponentially. People with antibiotic-resistant E. coli or golden staph (MRSA) bloodstream infections, for example, not only have a greater likelihood of death but the survivors spend, on average, an extra five days in hospital. This also increases health-care costs.
As superbugs develop resistance to more and more types of antibiotics, we may face a future without effective antibiotics. The only option, then, would be to revert to 1930s-style medical care to treat serious infection: surgically remove the infection, which may result in amputation.
There is, however, a lot we can do as individuals and as a community, through our governments, to improve the situation and reduce the risk of being infected with a superbug.
Reducing individual risk
Here are five ways you can reduce your risk of contracting a superbug:
- Maintain good personal care and hygiene. Regularly washing your hands with soap or alcohol gel is one of the most effective ways to protect yourself and those around you from infection.
- Make sure your health is as good as it should be, as this will optimise the body's response and immunity against bugs. This means making sure your immunisations are up-to-date and ensuring you seek timely medical care when something goes wrong.
- Limit the antibiotics you receive. More than half of antibiotics used in people are to treat viral infections, for which antibiotics do not work. Whenever you see your doctor and are prescribed antibiotics, ask if you really need to take them.
- Be vigilant when travelling. In developing countries such as India, many people acquire superbugs through water and food. Uncooked meats contain large numbers of bacteria and fruits and vegetables are frequently cross-contaminated. Only drink boiled water or water from a reputable supplier and eat hot foods, as heat kills these bacteria. With fruits, make sure the skins have been cleaned and you peel the fruit yourself with clean hands.
- Avoid medical tourism. Health-care facilities in developing countries have extremely high rates of superbugs compared with Australia.
Governments also need to do much more to reduce the threat of superbugs in the community.
Use in animals
Worldwide, about 80% of all antibiotics are used in food animals. High volumes are added routinely to animal feed or in water to prevent disease and, at times, to promote growth. But these antibiotics provide no or marginal benefit. The use of antibiotics as growth promoters should be banned as soon as possible.
Currently, some of the most important classes of antibiotics are fluoroquinolones and third-generation cephalosporins. But around the world, large volumes are used in food animals. If these classes of last-resort drugs are ineffective because of resistance, there may be no therapy for life threatening infections.
Antibiotics classed as "critically important" by the World Health Organization should be reserved for use in people.
Renew our focus on safe water
In the developing world, large numbers of superbugs are acquired and spread via water. In New Delhi, multi-resistant bacteria such as New Delhi metallo-beta-lactamase 1 (NDM-1) can even be found in the chlorinated water supply.
The availability of clean, safe water for everyone in the world would make a huge difference to our superbug problem. It will stop their spread to large numbers of people, as well as to and from food animals.
Back home, the most effective way to decrease the spread of superbugs in hospitals is to enforce strict hand hygiene policies. We should encourage patients to be more assertive and say to their doctors or nurses "I'd like to see you clean your hands before you touch me". Portable small containers of alcohol hand rub are a good alternative to soap and water.
Hospital design can also decrease the spread of superbugs. Providing each patient with a toilet for their own, for example, reduces the need for multiple patients to share bathroom facilities, and, inevitably, superbugs.
Research, development and control
Governments must invest in ongoing research to find new classes of antibiotics, improved vaccines and finding better way to stop the spread of superbugs.
We also need better surveillance of antibiotic-resistant bacteria in people, foods and food animals.
And finally, the international community must implement better controls on antibiotic usage. All antibiotics (human and agriculture) should be on prescription and usage patterns captured.
Superbugs are with us and increasing worldwide. We as individuals and as a community can however do many things to lower the risk of superbugs.
Peter Collignon is Professor, infectious diseases and microbiology at Australian National University. Peter Collignon does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.