The threat of antibiotic resistance

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The threat of antibiotic resistance

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Retired teacher Lill-Karin Skaret counts herself lucky, after having a close call with a bacterium resistant to many antibiotics.

The Norwegian grandmother had just arrived on holiday in India when she broke her leg in a car crash.

While at hospital in India she picked up bug, before being flown home to Norway.

“From the airport to the hotel there was this accident,” she said.

“I got home, eventually. I got a phone call from the doctor, and he said that I had this Klebsiella they had found, a bug which was very dangerous. I had to be very careful, and that people around me had to take care also.”

Lill-Karin had been colonised — but not infected — by a potentially lethal bacterium.

The strain of Klebsiella she was carrying is so resistant that there is only one antibiotic available that can be used to treat it.

Anna-Pelagia Magiorakos, an expert in antimicrobial resistance at the European Centre for Disease Prevention and Control puts the case into context:

“What’s important in Lill Karin’s case is that the Norwegian health care system was able to immediately screen her and put her in an isolated room until they had the results. This was very important because it probably prevented the hospital from having the spread of this very resistant bacterium,” she said.

Norway has a great track record in finding and containing antibiotic resistant bacteria like those picked up by Lill-Karin.

One reason is that patients hospitalised abroad are screened and isolated.

Gunnar Skov Simonsen, the head of the department of Microbiology and Infection Control at the University Hospital of North Norway explains how the isolation room works: “So there is a special ventilation system. So when you walk in there’s a little separate room in front, when first you enter, you close the outer door, then you’ll go through the washing procedure, and then afterwards you can enter the patient room.”

The other side to dealing with resistance in bacteria is to not allow it to develop in the first place.

Doctors here in Tromso follow a strict discipline of using antibiotics correctly and only when necessary, and testing patient samples to make sure the correct antibiotics are being used.

Gunnar explains: “And here we can see some examples of the tests that we are doing. You can see that the white carpet on the bottom of the dish is the bacteria, and then we can see antibiotics being impregnated into these strips, and when there is a zone around you can see that the substance is effective to kill or inhibit the microorganism, wheras when they grow all up to the strip it means that this drug is not effective.”

Holding up a sample with only one cleared strip he continues: “And as you can see on this one we don’t have much choice, there’s only just a single substance that will have any effect on this microorganism.”

Resistance can develop for several reasons: when too many antibiotics are used, when patients aren’t given the right antibiotics, take them for the wrong amount of time, or when they don’t need them.

Bacteria can also mutate and develop resistance on their own.

And the problem is widespread, as Anna-Pelagia confirms: “We associate antibiotic resistance with the hospital frequently, but it’s important to note that it exists in the community as well.

“We’ve seen over the past few years that some bacteria actually through sustained efforts that certain countries have applied have been able to decrease their rates of resistance. On the other hand, we have other bacteria that have been slowly been increasing throughout Europe and the world,” she said.

That increase is a threat not only in hospitals, but also in the wider community.

Resistant bacteria can be picked up anywhere, as Italian university professor Paolo Visca found out when he set off from the port of Nettuno near Rome on a fishing holiday.

After a few days he fell ill with a serious urinary tract infection.

Paolo’s symptoms were worrying: “In the initial stages I had a classic septic fever with shaking chills, profuse sweating, not being able to go to the bathroom, to urinate, and so the problem was really serious at the beginning.”

Anna-Pelagia explains what happened:

“In Paolo’s case he had an E.coli urinary tract infection, which is the most common bacterium that causes these infections. In his case he had an E.coli which was resistant to multiple antibiotics. And what’s significant is that he took an antiobiotic that should have worked, and it didn’t because it was resistant to that and a number of other ones.”

It took two months and three courses of different antibiotics before Paolo’s infection was successfully treated.

Nobody knows where he picked up the infection.

So what did he learn from the experience?

“Never self-medicate, never treat your illness by yourself thinking you know how to treat it; always go and see a doctor, your GP,” he said.

Both doctors and patients have their role to play, and campaigns like European Antibiotic Awareness Day aim to keep the issue in the public eye.

In Bologna, Maria Luisa Moro has spent the last decade promoting the message that antibiotics shouldn’t be overused and should be used correctly.

She is Head of the Infective Risk Unit at Emilia-Romagna Regional Health and Social Authority, and has recently used children’s evocative drawings of antibiotic resistant bacteria as a visual tool to promote awareness.

Parents are one of Maria-Luisa’s priority groups, along with the elderly residents of retirement homes.

“The most common infections, those for which antibiotics are mostly used are the upper respiratory infections in children, because children have an elevated risk of infection, often from viruses, which are incorrectly treated with antibiotics. The other main group under risk of infections inappropriately treated with antibiotics are urinary infections in adults,” she explained.

The threat is growing, since new strains of bacteria resistant to antibiotics are being spread across Europe.

But experts like Anna-Pelagia from the European Centre for Disease Prevention and Control are convinced that this threat can be contained.

“I think that it’s possible in the future that if everyone is able to use antibiotics correctly, and if infection control practices are used correctly I think that we can turn the tide. But it has to be done in a very structured manner, it has to be taken very seriously, because this is an issue of patient safety,” she said.

An issue of patient safety that has left lasting memories for those who have faced infection from these very resistant bacteria, the so-called superbugs.

At home in Norway, Lill-Karin reflects on events: “When I get a distance from it, then I realise more how serious it was. When I was in the middle of it, I just had to survive from day to day.”

In Marina di Nettuno Paolo looks back at what happened: “In my case I was lucky, and I consider myself relatively lucky since a series of favourable circumstances made it possible for me to receive the correct treatment in the end. But I think I ran a serious risk.”

A risk that we all could face unless antibiotics are only used at the right time and in the right way.

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