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Superbugs on the rise

Published Jul 22, 2023


Drug-resistant bacteria increasing ‘exponentially’ and leading to ‘last resorts’

Durban - The use of “last resort” antibiotics is increasing “exponentially” as more “superbugs” prove to be unbeatable.

Bacteria, viruses, fungi and parasites are “learning” to evade current treatments, causing longer illnesses and even death, and treatment options for common infections are running out.

Exact numbers are not available for South Africa, but a recent report in the Lancet and World Health Organisation data stated that globally antimicrobial resistance (AMR) was associated with the deaths of nearly 5 million people.

Professor Sabiha Essack, the South African Research chairperson in Antibiotic Resistance and One Health and Professor of Pharmaceutical Sciences at the University of KwaZulu-Natal, said data showed it was a growing problem in the country.

“As much as I can’t give you statistics in terms of how many hospital-acquired infections are caused by drug resistant bacteria, I can tell you from aggregated information that we have a problem and it’s escalating in South Africa.”

Data from one laboratory network in the private sector and national data in the public sector showed an exponential increase of bacterial resistance to “last resort” antibiotics, and rampant increase in the procurement of last resort antibiotics or reserve antibiotics.

Essack is engaged in a One Health study on AMR focusing on patients in public sector hospitals, intensively produced food animals like chicken and poultry, and wastewater.

She said the increase in AMR in human health was largely fuelled by the indiscriminate use and overuse of antibiotics – mainly in the private sector – and the low rate of laboratory testing in public hospitals to determine the identity and antibiotic susceptibility of the bacteria causing infection to guide treatment.

“Generally, bacteria are almost always resistant to one or more antibiotics.

And increasingly, we’re seeing multidrug resistance in several of the isolates that are processed in our public as well as private laboratories.”

She said drug procurement backed up the data that AMR was on the rise.

“Because we’re buying so much more, we know that our reliance on the reserve (broad spectrum) antibiotics is increasing because we’ve got extensive resistance to the access (narrow spectrum) and the watch (second line) category of antibiotics.”

She said AMR and superbugs in particular posed a huge health risk to immunocompromised patients like those with cancer and autoimmune conditions or those with comorbidities like HIV, TB and diabetes.

“If you are in a ward that is very full and you have a hospital-acquired infection which is multidrug resistant, and unfortunately, not many of our hospitals have isolation rooms …(then) it spreads to all of the other patients.”

National Department of Health spokesman Foster Mohale said 2019 and 2021 reports from the Surveillance for Antimicrobial Resistance and Consumption of Antimicrobials in South Africa, showed increasing levels of resistance to ESKAPE organisms (Enterococcus faecalis, E. faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, Escherichia coli).

“This is not exclusive to South Africa,” said Mohale.

According to the WHO website, antimicrobials include antibiotics, antivirals, antifungals and antiparasitics.

The WHO said AMR represented a major threat with global economic and security implications with current treatment becoming ineffective and infections persisting in the body, increasing the risk of transmission to others.

Essack said that, despite the gravity of the situation, the problem could be remedied by more diagnostics, more vaccines and fewer antibiotics.

She warned parents that the more they treated their children with antibiotics, the fewer drugs they would be able to rely on when they were older.

“I don’t arbitrarily say stop use or reduce use because you’re certainly going to need antibiotics. They are warranted in certain circumstances, but we need to use them correctly.”

It was imperative, she said, to use the most narrow spectrum antibiotic but because of financial constraints in public hospitals most of the treatment was empiric, meaning doctors were not treating patients based on microbiology investigations or diagnostics but rather used their own judgement.

“So within the public sector, when it comes to budget austerity, the microbiology budget goes first… we don’t routinely take samples for every suspected infection within the public sector.

“You don’t really know whether you’ve got a superbug in a hospital until the person is not responding and that infection is escalating and spreading into the bloodstream.”

Doctors in government facilities have to adhere to the standard treatment guidelines and the essential medicines list and have a restricted list of antibiotics.

“In the private sector, there’s no restriction, and I have personally observed quadruple cover where prescribed antibiotics perform the same function,” said Essack.

While antibiotics kill infectious bugs, they also kill bugs that support good, healthy microbiomes in our systems.

“Some bacterial populations replicate almost every 20 minutes.

“There will be one that will change slightly or mutate and become unaffected by the antibiotic, and that becomes a resistant population, that will survive at the expense of the sensitive population.”

Essack said humans could change this by reducing the use of antibiotics, thereby reducing resistance.

Mohale said antimicrobial resistant organisms were also found in animals, food, plants and the environment, and could spread between people as well as people and animals. Apart from the health implications, the economic costs were significant.

“In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those impacted,” he said.

Other drivers in the spread of drug-resistant pathogens include lack of access to clean water, sanitation and hygiene for humans and animals; poor infection and disease prevention and control in health-care facilities and farms, said Mohale.

Essack said people with healthy functioning immune systems could fight various illnesses and urged people to practise good hygiene.

The Independent on Saturday