Head of the Infection Supervision Service, doctor – infectologist, hepatologist
As a result of increase of the antibiotic resistance of bacteria or ability of bacteria to survive in contact with antibiotics, it becomes increasingly more difficult for doctors to identify the disease initiating bacteria; therefore, the risk of choosing wrong antibiotics is constantly increasing. This may be even lethal for a patient. Forecasts show that by 2050 the highest mortality rate in the world will arise exactly from diseases, which are caused by antibiotic non-sensitive microbes, which are most frequentlyspread directly from the carrier, through environment or ingested with food, especially meat.
In Latvia, there are thousands of patients, who are carriers of antibiotic-resistant bacteria
10 years ago, only 2-3 patients had presence of resistant bacteria among all patients admitted at hospital in one month. Currently, the situation has changed significantly – now already 3 patients each day are insensitive to antibiotics. It causes a serious problem to medical practitioners – if a doctor is unable to determine initially, whether the particular disease is initiated by a resistant or sensitive bacteria, we may choose wrong antibiotics, which, in its turn, leads to a risk of losing a patient during the initial stage of treatment. Identification of bacteria and determination of antibiotic sensitivity requires at best two to three days, prescribing the right antibiotics. In the last three years, all hospitals in Latvia are required to provide the Centre for Disease Prevention and Control with data on how many of such patients with resistant bacteria are admitted by each hospital. By doing so, data on the general situation is collected and analysed. Riga Eastern Clinical University Hospital alone admits approximately 1,200 patients with resistant bacteria annually. This number also involves patients, who cannot be helped and, unfortunately, the outcome is lethal.
A person can pick up resistant bacteria in various ways. They can get into our body or on the skin directly from the carrier of bacteria as a result of contact. They also can be picked up from the surrounding environment, for example, at hospital, as well as in other public places. Resistant bacteria can be ingested through food, using food products, for example, meat, if antibiotics are used in the case of any disease of livestock during the breeding process. It has to be said that by now picking up of bacteria through food is paid too little attention; however, its impact on the prevalence of antibiotic resistance is growing rapidly.
New medicines alone do not solve the problem
Prevalence of resistant bacteria can be limited, and it has to be done at all levels. For persons involved in the healthcare, this primarily means strict observing of three basic things – correct prescription of antibiotics, disinfection of hands before and after patient examination, and isolation of infected patients. A doctor shall be able to assess very qualitatively, when antibiotics are required, which is one of cornerstones – very strictly considered necessity of antibiotics. Also upon arrival of such patients at hospital, they should be isolated to prevent further prevalence of these bacteria.
The resistance of bacteria is limited by new medicines, which are capable to fight various infections caused by bacteria. Unfortunately, it is a temporary solution, because new medicines will help only during the initial stage. Sooner or later we come to a conclusion that bacteria become resistant also to these medicines. This process can be compared to a fight with windmills, because, on one hand, new antibiotics are required, and, on the other hand, we understand that antibiotics, which were invented relatively recently – 10 to 15 years ago – are already inefficient. Resistance to these antibiotics has already developed. Considering all these aspects, we fight at the hospital to prescribe antibiotics only when it is really necessary for a patient.
Taking into account the prevalence of antibiotic resistance, the sector in general has to consider, how antibiotics affect the environment we are living in, similarly as the society currently pays attention to ecological issues and ecological solutions in their daily life.
Challenge – picking up of resistant bacteria through food
One of areas, which are paid relatively little attention to globally and in Latvia – prevalence of antibiotic-resistant bacteria through food. One of products, which causes the biggest concern about it containing residues of resistant bacteria is meat, if the livestock intended for producing meat has been ill and treated with medicines.
What happens in our body, when consuming such food? The resistant bacteria gets into the acid gastric environment. Some of the bacteria are killed by saliva, whereas other become “inhabitants” of the body. There are many bacteria in the intestinal tract, and, while living in specific favourable conditions, bacteria may cause some infection. A study shows that, after picking up resistant bacteria, in 42% of patients they have still remained in the body after one year. This means that we cannot know clearly, how long bacteria can survive in our body. Even such cases have been observed, when presence of such bacteria lasts 10 and more years; at the same time, there have been cases, where a patient leaves the hospital, changes the environment, and resistant bacteria are not observed anymore. If a human body contains resistant bacteria, treatment is more complicated, because we cannot be sure, that antibiotics will work.
I am glad that certain food manufacturers have already found a solution and offer it to the society. Though, currently only one manufacturer – “Putnu fabrika “Ķekava”” – offers in stores chicken meat with marking “Raised without antibotics”. It is a significant evidence that use of antibiotics in agriculture can be maximally limited. This model of livestock breeding is very widespread in Scandinavia, and we have something to strive for.
Cooperation among various fields on a national scale
Fighting of antibiotic resistance is a national team work, because cooperation of all involved parties – healthcare sector, agriculture and food manufacturers – is significant in mitigation of the problem, considering that picking up of resistant bacteria is possible in many various ways – by ignoring hygiene requirements, through the food chain, and through direct contact with the carrier of bacteria.
At the moment, there is progress in cross-sectoral cooperation, because the problem becomes increasingly more topical for all involved parties. In November 2018, antibiotic resistance limitation and cautious use plan “One Health” 2019 – 2023 was presented. The main tasks of this plan is to improve the quality and analysis of data on antibiotic resistance and consumption of antibiotics, promote cautious and responsible consumption of antibiotics both for humans and animals, improve prevention and supervision of infectious diseases both in the area of public health and animal health, improve research in the field of antibiotic resistance, as well as to promote understanding of specialists and public concerning responsible and cautious use of antibiotics.Back