Friday, November 22, 2013

How to reduce the risk of antimicrobial resistance in practice

Some claim we are already living in the post-antibiotic era - but steps can be taken to reduce antimicrobial resistance.
You may have read a very sad article this week about a man who contracted a panresistant bacterial infection and died having spent most of the year in isolation. 

The implications are profound and these were discussed eloquently at the Australian Society for Infectious Diseases symposium in July last year.

A true post-antibiotic era would render interventions we take for granted, such as major surgery, organ transplants, chemotherapy and successful treatment of pre-term babies almost impossible. Relying on drug development alone will fail - it is well documented that the pipline of new antibiotics is dwindling.

But steps taken by individuals DO HELP. Several studies have shown that antimicrobial resistance is reduced - and occasionally eliminated - when use of specific antimicrobials is reduced or avoided. 

The use of therapeutic guidelines for empirical treatment can be extremely helpful in this regard, as can other measures such as hand hygiene, surgical debridement of wounds and topical prepations of some medication.

The British Small Animal Veterinary Association has been promoting a strategy to PROTECT antimicrobials. You can download their excellent poster here

In a perfect world, we would perform a culture and sensitivity in every suspected infection, treat appropriately and culture post-treatment to confirm resolution. Not only would this benefit the individual by allowing treatment to be tailored and avoiding unnecessary medications, it would also allow vets to keep track of the sorts of agents involved in common infections and how these might be changing.

In veterinary land one disincentive for culture and repeat culture is cost - clients must pay vets for these tests, and vets must pay labs. If antimicrobial resistance is a public health issue, is this a test that could be subsidised in some way?

Next week the Marie Bashir Institute for Infectious Diseases and Biosecurity will be hosting a brain-storming session on novel approaches to vexing problems: antimicrobial resistance and emerging infectious diseases.

For more information, click here.