Study on antibiotics reveals disturbing links
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Durban - A critical-care physician has warned that the benefits of antibiotics might be lost for ever if the drugs were not used properly now.
The emergence of pathogens that were resistant to many drugs, coupled with the abuse of antibiotics, had long been seen as a global crisis, said Professor Guy Richards.
The South African intensivist was speaking at the 11th Congress of the World Federation of Societies of Intensive and Critical Care Medicine at the Durban ICC at the weekend. The conference was attended by about 1 500 delegates.
Richards raised concerns about the link between medics’ hand hygiene, which he described as “awful”, and the spread of drug-resistant bacteria. He said it was only after extreme drug-resistant organisms began to appear in South Africa that researchers took a closer look at antibiotic prescription practices in public and private ICUs.
In 2011, the deadly superbug, Klebsiella pneumonia, was identified in a Johannesburg laboratory for the first time, and others, including RPC-2 e. cloacae was found in Pretoria, and OXA-48 in Johannesburg, Cape Town and Port Elizabeth.
Referring to a study titled “Prevalence of Infection in South African Intensive Care Units”, Richards said a number of highly disturbing issues were highlighted by this first close look at the use of antibiotics and patient outcomes in the country.
He said that the study had shown that 43.5 percent of antibiotics used in public hospitals, and 60 percent in private hospitals, were inappropriate.
The study also found that antibiotics were used for too long. Richards said this was in spite of the fact that researchers had been liberal with the time period, allowing 10 days to pass before use was deemed inappropriate.
However, he said the most “distressing” thing to emerge from the study was the number of antibiotics prescribed at any one time. Some patients were receiving up to 10 at one time, he said. This excluded anti-TB and antiretrovirals.
“It is a case of starting with one and, when a patient didn’t immediately get better, adding another and then another and then another.”
Richards said that the spread of drug-resistant bacteria either took place through the genetic transfer of resistance from one bug to another or, through colonal spread which saw the same bug being transferred from one patient to another, primarily as a result of poor infection control.
“The most important thing of all is to decrease the amount of infection. You need to examine hand hygiene which is awful in general,” he stressed, saying that studies had revealed that hand-washing transgressions covered a wide spectrum of medical staff.
This was not just restricted to nurses or even physiotherapists, but also extended to senior medical staff.
He said that while surgical staff scrubbed up well in theatre, they washed their hands 83 percent less often than their peers in wards, while anaesthesiologists were the worst when it came to compliance.
Richards also said there was a need to understand how antibiotics could be used to actually decrease the development of resistance.
This required an understanding of the “minimum inhibitory composition” and the nature of antibiotics, so that dosages of time-dependent and concentration-dependent antibiotics could be adjusted to increase the potential efficacy, while controlling the duration of use.
He said that one of the big problems was adding therapies for patients, which were failing. For example, when sepsis was present, it was necessary to look at source control, he said, rather than simply “throwing another antibiotic at it”. - Daily News