The development and spread of antibiotic-resistant bacteria is one of the greatest threats to human health today. The incorrect use of antibiotics, medical tourism and natural resistance all play a part.

In July 2013 a Wellington school teacher died in hospital from complications of a stroke following 6 months of quarantine. The hospital reported that the man, who had received an emergency operation in Vietnam and an earlier hernia operation in India, was infected with an antibiotic-resistant called Klebsiella pneumoniaebacterium, aka KPC-Oxa 48.

The case is significant as he is believed to be one of the first New Zealand carriers of an aggressive bacterium resistant to every type drug of tested in hospital lab experiments.

Medical tourism and potential risks

The Dominion Post reported on the case on 19 November 2013, and the article included a plea from Wellington Hospital disease physician Dr Michelle Balm for people to realise the dangers of medical tourism.

She is quoted as saying, “We would encourage people to think very hard about the consequences of it – we recognise people’s desire to get things done, but the risks are so great.”

Incorrect use of antibiotics partly to blame

Medical experts are unanimous in laying part of the blame for the rise of antibiotic-resistant bacteria on the inappropriate prescribing of antibiotics or, in some countries, antibiotics being available over the counter as well as the excessive use of antibiotics in the agricultural sector in some countries.

This is because resistant bacteria are able to develop from exposure to the active constituents of antibiotics found in wastewater and sewage (passed from our urine and faeces when we are taking a course of antibiotics) – the genes the bacteria develop conferring resistance are then able to be passed from strain to strain. Note that resistance can also arise naturally in the environment as microbes battle it out for survival.

What can you do?

Some steps that individuals can take include making sure they and their children have all their recommended vaccinations, as many vaccine-preventable diseases or their complications may require antibiotics to treat them. If travelling overseas, make sure you have all the vaccines recommended for travel in that country in a timely manner so resistance has time to develop before going. Also, do not urge a doctor to prescribe you antibiotics, especially if your illness is not even bacterial. If you are prescribed antibiotics, take them as directed to reduce the chance of your infection returning and having to have another round of treatment.

Rethink ‘cheap’ overseas elective surgery

Don’t have elective ‘cheap’ surgery in developing countries. University of Auckland microbiologist Dr Siouxsie Wiles said in her blog that the strain the Wellington patient was carrying almost certainly originated either in India or Vietnam. “About 5 years ago, a class of these resistant microbes appeared in Europe and North America and were traced back to travel to India.”

Australian campaign highlights dangers

Unrelated to the Wellington event, but with remarkable timing, on 22 November, Australia’s government-funded NPS MedicineWise (NPS) issued a release as part of a campaign to highlight the dangers of antibiotic-resistant bacteria, urging parents not to kept left-over antibiotics or unfilled antibiotics prescriptions to use “next time”, saying that, instead, left-overs should be returned to the pharmacist for safe disposal.

NPS said in the release, “Australians are reminded that the development and spread of antibiotic-resistant bacteria is one of the greatest threats to human health today. Globally, and in Australia, we’re facing a return to the pre-antibiotic era where even minor infections could lead to death.”

Soap, water and common sense

In addition, Dr Mark Jones, a specialist clinical microbiologist and molecular pathologist at Wellington Hospital who worked on the Wellington case, said in a live chat about antibiotic-resistant bacteria, “I have never supported the widespread use of handwashes or shampoos. Soap and water and common sense are the best disinfectants. There is no mileage in killing harmless bacteria. Most of the time, they truly are our friends. 99.9% of germs are harmless. It’s the others that can kill you.”

Meanwhile, on 3 February 2014, the Medical Journal of Australia published an ‘online ahead of print’ paper urging hospitals to be ready for resistant bacteria, saying there will be an increase in patients arriving from overseas who have been infected by bacteria resistant to multiple drugs and highlighting the significant effort needed to quarantine and treat repatriated patients in local hospitals if we hope to reduce the spread of such organisms locally.

Useful links

Read the Dominion Post article and live chat with Dr Mark Jones, a specialist clinical microbiologist and molecular pathologist at Wellington Hospital who worked on the Wellington case, about antibiotic resistant bacteria.

Read the blog by University of Auckland microbiologist Dr Siouxsie Wiles about antibiotic resistance and the Wellington case.

    Published 14 March 2014