Tsunami of bacteria is on our doorstep
Sourced from The Sydney Morning Herald
Opinion - Peter Collignon
When Jane returned from her holiday in Thailand, she brought with her something far worse than a bout of traveller's diarrhoea. She brought home a superbug. And it landed her on my list of patients.
Superbugs are bacteria that are resistant to most, and sometimes all antibiotics. They are now causing many common infections in what is a major and growing international problem. Some of these infections have very limited options for therapy and will result in death.
Even when some effective antibiotics remain available, they are often difficult to deliver and very expensive. Often there will be no oral tablets and a patient will have to have their antibiotics through a drip - like Jane did. More importantly these remaining antibiotics can be much more toxic, with sometimes more frequent and serious side effects.
After her holiday, Jane developed a urinary tract infection. She needed three courses of a last line antibiotic (meropenem) to beat it. At least that drug was effective and relatively non-toxic. But the problem with her superbug was that even after we got rid of it from her bladder, it still lived in her bowel and came back repeatedly to cause more urinary tract infections.
Superbugs cause pain, suffering, time off work and interference with normal life - you are sick for longer and you have a greater chance of ending up with a disability. The worst case scenario is when an untreatable infection leads to death. We need to remember the times before antibiotics were available e.g. the 1920s, when a person had a Golden Staph bloodstream infection, there was an 80 per cent chance they would die. With antibiotic therapy, this mortality rate is now five times lower. But we don’t want to return to the days of the 1920s where although we have antibiotics, they don’t work.
The most rapid rise and often the worst type of superbugs occur in developing countries. In India, about half of all community-onset urinary tract infections caused by E.coli are for practical purposes now untreatable. These untreatable bugs can pass to people by many routes. It’s not only person to person, but via foods and water. In some countries, even when the water supply is chlorinated, untreatable E.coli remains present.
In Australia, we often worry about a “post-antibiotic” era full of superbugs; for practical purposes a large proportion of the world’s population is already in a “post-antibiotic” era.
Australia does have some very difficult to treat bacteria which can cause problems both in hospitals and in the community, but these are still relatively rare. Travellers are at increased risk of introducing superbugs into Australia because they pick them up through foods and water while overseas.
Another patient I treated was a young woman returning from India with a ruptured appendix, who had an ongoing abdominal infection that could not be treated easily. Men also suffer from prostate superbug infections after returning from overseas holidays. These infections can come back again and again, sometimes with life threatening septicaemia. When standard antibiotic therapy doesn’t work, anxiety and apprehension are common.
We need to do everything we can to protect ourselves and our community from superbugs. This means using less antibiotics in people and in animals reared for food. And we need to stop superbugs from spreading. Good hygiene and infection control are essential. Internationally this means helping everyone access clean water and proper sanitation. We need adequate healthcare delivery so we can prevent infections and treat them effectively.
Australia is an island, but this doesn’t stop us being at risk. There is a potential tsunami of resistant bacteria at our doorstep. Already these are being brought in by travellers and potentially by imported foods (prawns and seafood, for example). When we get exposed to larger numbers here, they will likely spread more quickly. We must do more at home and internationally to hold back the tide.
Peter Collignon is an infectious disease physician in Canberra and a professor at the Australian National University medical school.