AUSTRALIA now has the highest rate of one deadly superbug in the world as our overuse of medicines is fuelling the rise of infections resistant to even the last line of antibiotics. A damning new report shows antibiotic use in Australia is higher than in England, Canada, Norway, Denmark and Sweden with half our population using the medicines every year. Its left us with the highest rate of one deadly superbug — vancomycin resistant enterococcus faecium (VRE) — in the world. This bacteria can live innocuously in the human intestine, but when it becomes pathogenic it cases diseases such as neonatal meningitis or endocarditis a disease that can destroy heart valves.
The Antimicrobial Use and Resistance in Australia (AURA) report 2016 to be released Thursday shows half the GP scripts written for antibiotics are for colds and flu even though these illnesses are viruses that don’t respond to antibiotics. And as the cold and flu season hits us in full swing this season, experts have been urging Australians not to ask their doctor for an antibiotic because they could be helping deadly superbugs spread.
The report shows a strong seasonal variance, with some antibiotics being prescribed more in winter.
“Antibiotic resistance has developed because of the overuse and misuse of antibiotics, and now, bacterial infections that were once easily cured with antibiotics are becoming harder to treat,” said Australian Commission on Safety and Quality in Health Care Senior Medical Advisor Professor John Turnidge.
The results of the first comprehensive study on Australia’s antibiotic use includes data from 182 doctors’ practices.And it shows on any given day in an Australian hospital in 2014, nearly four in ten patients were being administered an antibiotic.One in four of these medicines were prescribed in ways that were not compliant with guidelines, and another one in four were considered inappropriate.
The Antimicrobial Use and Resistance in Australia (AURA) report 2016 found where GPs gave a reason for prescribing an antibiotic 50 per cent of patients had a cold or upper respiratory tract infection.A new NPS MedicineWise survey of 1000 Australians, also released today, has revealed that four in ten people who went to the doctor last time they or their child had a cold or flu expected a prescription for antibiotics.
One in five people said the main reasons they asked a doctor for antibiotics when they had a cold or flu were they hate being sick, 17 per cent said they believed that antibiotics help you get over cold or flu more quickly and 22 per cent said they couldn’t take time off work or family duties.
“It’s timely for us to again address common misconceptions that unfortunately seem to persist about appropriate use of antibiotics during cold and flu season,” said NPS MedicineWise CEO Dr Lynne Weekes.
As experts try to turn around Australia’s addiction to antibiotics the report will be used as a benchmark to measure improvements or declines in antibiotic stewardship in the future.
Staphylococcus aureus, commonly known as Golden Staph because of its colour on a laboratory plate, is normally harmless. Carried on our skin it can, sometimes, cause minor infections in wounds or create boils.
Golden Staph, though, is becoming resistant to the most powerful of antibiotics and returning as a big problem in most large Australian hospitals, attacking intravenous lines, catheters and wounds after operations. It spreads quickly through patient contact, respiratory droplets and food. These resistant bacteria range from 20 to 40 percent of all Golden Staph infections in major eastern Australian hospitals. About 5 percent of those multi resistant Staphylococcus aureus (MRSA) can only be treated with vancomycin. Now, even that last line of defence is looking shaky. In 1997, a Golden Staph bacterium partially resistant to vancomycin was discovered in Japan. Dubbed to be of intermediate resistance it is now known as vancomycin intermediate Staphylococcus aureus (VISA). VRE is another bacterium which hits the headlines from time to time. VRE or Vancomycin Resistant Enterococci was first identified in Australia in 1994. It didn’t, though, cause much of a stir until 1996 when several cases were diagnosed in hospital patients across the country. In that year, institutions in Sydney, Brisbane, Perth, Melbourne and Newcastle all reported isolating VRE.
Enterococcus is a bacterium in our gastrointestinal and genital tracts. It can be highly aggressive, especially in post-operative hospital patients, causing urinary tract infections, septicaemia (blood poisoning) and endocarditis (heart infection) as well as infecting wounds. Microbiologist and antibiotic resistance expert, Dr John Turnidge, from the Adelaide Women’s and Children’s Hospital, says Enterococcus is a ‘peculiar beast’ because it starts off as naturally resistant to many antibiotics. “For severe hospital infections, there are only two classes of antibiotics to choose for treatment so resistance in one class, no matter how low, is a huge concern”. Less than 1% of Enterococci resist vancomycin but some also resist the other antibiotic available in that class in Australia. This combination makes serious Enterococcus infections potentially unstoppable.
“Antibiotic resistant genes from VRE.have been transferred to Staphylococcus Aureus in the laboratory. If such resistance occurs in nature, or the Japanese strain [VISA] behaves like the multi resistant S. aureus, then a spread throughout the world may occur over the next ten years putting treatment of S.aureus back where it was before antibiotics were first discovered.”
Then there’s the bacteria that causes those nasty common problems like middle ear infection, sinusitis, bronchitis and life threatening pneumonia. Streptococcus pneumoniae spreads through respiratory droplets and can also cause meningitis and septicaemia. It’s been evolving resistance around the world and Australia’s catching up. At least half of Australia’s strains are resistant to one antibiotic and a third are resistant to 3 or 4 antibiotics. Given the large numbers of people who suffer infections caused by Streptococcus it is, in one sense, much more important than VRE or Golden Staph.
There is also some concern in Australia about Haemophilus influenzae. Also passed on through respiratory droplets, it causes bacterial meningitis, middle ear infection, sinusitis and bronchitis – not influenza as its name might suggest. There is now a successful vaccine for bacterial meningitis but about 25 percent of Haemophilus influenzae resist the most commonly used antibiotic. Very little multi-resistance has been identified at this stage.
Then there are the sexually transmitted diseases. Gonorrhoea has become more and more resistant to antibiotics since the Vietnam War. It now resists penicillin, tetracyclines and the newest groups of antibiotics.
Probably the most common bacterium is Escherichia coli commonly known as E-coli. It can cause gastroenteritis, haemorrhagic colitis or urinary and genital tract infections. Its resistance is very high and getting worse. 50 percent of Australian strains resist the most commonly used cure, Amoxycillin.
On the international front, Campylobacter, which causes gastroenteritis and is passed on through animals, is showing resistance to a class of antibiotics called quinolones. Like Salmonella, which is also showing resistance, it comes from food and water. Antiobiotic-resistant Campylobacter is a big issue in Europe and the US especially in relation to the use of similar antibiotics in food producing animals.
Also of concern is the growing rise in multi-drug resistant Tuberculosis. Initially, these strains were seen only in HIV-infected patients but it has spread into the general community. It’s now at the stage where Australia’s state health departments have had to issue instructions to practitioners on treatment for multi-drug resistant TB.
“Overall, there are almost no bacteria where there is not resistance to more antibiotics then there were 10 or 15 years ago,” says Associate Professor Peter Collignon, Director of Infectious Diseases and Microbiology at the Canberra Hospital, Australian Capital Territory.
Tegan, Nutrition Nourishment