Antibiotics use fuels rise of the superbugs
Originally published on The Australian
Aged-care facilities and hospitals remain hotbeds for the overuse and misuse of antibiotics, fuelling the rise of superbugs and creating a serious infection risk in the community.
According to the third annual surveillance report from the Australian Commission on Safety and Quality in Health Care, several superbugs continue to pose a threat, with E. coli building resistance to frontline antibiotics.
Salmonella, Neisseria gonorrhoeae and Neisseria meningitidis too are increasingly resistant. Of particular concern is the evolution of Staphylococcus aureus and its geographic shift. Rates of community-associated methicillin-resistant Staphylococcus aureus (MRSA) are dropping in hospitals but rising in the community, particularly in remote areas and indigenous populations.
“We don’t know what the end of the MRSA expansion in the community is at the moment because we don’t have anywhere in the world to compare it to,” said the commission’s John Turnidge.
Resistance builds as a result of the overuse and misuse of antibiotics. Despite programs intended to ensure best practice among health professionals, the rate of inappropriate prescribing in hospitals has remained static at about a quarter of all scripts, while the rate in the community is declining but still well above recommended levels.
With an early flu surge this year, more than half of those infected may be given antibiotics for which there is no evidence of benefit. The report found aged-care facilities had worrying antibiotic practices, coupled with “high levels of infection and colonisation with multi-drug-resistant organisms”.
Professor Turnidge said MRSA had become common in aged-care facilities — some estimates put it at about a third of all Staphylococcus aureus samples — and the commission was working with the sector to improve antibiotic prescribing practices.
“We don’t have an accurate picture but we do have enough of a picture to see there is a problem,” he said. “A lot of strange practices have built up in aged-care facilities over many years.”
Professor Turnidge expressed surprise and disappointment that practices in hospitals had not improved, particularly in relation to antibiotics given with surgery.
“But we are trying to change, literally, 60 or 70 years of practice and we can’t expect overnight success,” he said. “There will be a lag period of a number of years.”
But the rise of MRSA in the community was potentially a bigger problem. Preventing such superbugs and containing their spread was a major challenge, needing different approaches than in hospitals, especially if frontline antibiotics no longer work. “There’s quite a number of new antibiotics coming through but none of them are going to deal with this problem in the community as they are injectables and we are not going to be able to afford them in their current format,” Professor Turnidge said.
He said not only did superbugs make infections more dangerous, and harder to treat, they also took resources away from other areas of the health system.
Kathryn Daveson, the clinical director of the Antimicrobial Use and Resistance in Australia surveillance system, said there was a particular need to reduce inappropriate prescribing of broad-spectrum antibiotics for urinary tract and skin infections.