face mask, infections, epidemics, flu

The silent killer

Forget a nuclear holocaust or climate change. The next pandemic is likely to be antibiotic resistance.

Health authority have been warning for years about the consequences of overuse of antibiotics. Before they were introduced in the 60’s, a simple tooth infection could and did kill. 

700,000 people presently die annually as a result of superbugs.

This number is expected to become 10 million by 2050.

Frank Warstrer a professor at the Technical university of Denmark in Copenhagen heads the reference laboratory on antimicrobial resistance for the European Union, the World Health Organisation and the Food and Agriculture organisation of the United Nations. He has studied the rise of superbugs for 25 years.

Studying sick people in hospitals is not the full picture, only a small part. 

The reason is we need big data in order to fight global pandemics.

And currently we don’t have this data

Most people who harbour antibiotic resistant bacteria in their gut are not sick, and have not idea of the risks they host.

One of the biggest problems according to Professor Warstrer is getting hold of fecal samples across the world. These bugs need to be tracked outside of hospitals, in the community, in healthy as well as unhealthy people. They live in our guts and ‘if we don’t monitor, we can’t manage’.

Only monitoring sick people in hospitals is not enough data.

Airplane waste tanks contain fecal samples to monitor. He looked at the raw sewerage from plane coming into Copenhagen.  Eighteen long haul flights, across 9 cities and 3 regions.

Largest amount of antibiotic bugs were more common from Asia. Lowest resistance was North America. He published his results four years ago. 

A global superbug tracking system.

He asked for global collaboration and more global samples. He collected sewerage from 70 cities, in 60 countries. He looked for drug resistant genes carried by bacteria. 

He analysed the DNA. There was a large difference in amount of antibiotic bacteria across regions. Basically the world is based into two basic groups. The results were published in March

Africa, South America and Asia one group. North America, Europe, Australia another.

Differences are linked to sewage disposal and public education.

Recently the Netherlands faced a serious problem, yet more and more people were getting sick with antibiotic resistance. The Netherlands have always been cautious in antibiotic use. There was no connections.

It was a gene that e-coli and other bacteria held, called ESBL that overcame all antibiotics. 

The cause turned out to be pigs being given antibiotics, that created superbugs that were then passed on to people. In animals antibiotic use has been traditionally high. The Netherlands were giving five hundred tons a year of antibiotics to their animals, while being very cautious in giving them to people.

Bacteria cultured from meat products bought in the Netherlands had their DNA analysed. This data was compared to patients in hospitals diagnosed with antibacterial resistant bugs. It turned out there was a link between the two.

Poultry turned out to have the highest rate of antibiotic resistant DNA, with eighty percent of chickens testing postive to ESBL. The infections they cause are usually treated with a last line of resistance antibiotics. 

While cooking kills bugs, raw meat spreads bugs via chopping board and cooking utensils.

The EU banned the use of antibiotics as growth promoters in 2006, but farmers continued to use them, due to animal welfare and concerns over income.

Political pressure grew as superbugs continued to spread in humans.

Finally the animal feed sector stopped adding antibiotics to food. Certain critical antibiotics were completely banned. Systems were put in place to track antibiotic use by each industry and each farm.

The United States have also banned certain antibiotics. However injectable antibiotics are still used in 90% of US pig farms and 80% of cattle feedlots. The US does not have the central control over farmers that Netherland farmers have. Each farm has it’s own dedicated vet and farmers can’t shop around for vets.

In a couple of years the Netherlands reduced by half the number of antibiotics used in animal husbandry. Animal antibiotics have since falled by two thirds over the past decade, without any discernible problems for animal welfare or raised costs for farmers. The superbugs being detected on poultry meat have subsequently fallen.

The Dutch experience has sparked interest. Other countries are following suit.

France, Germany and the UK have since implemented measures to curb antibiotic use on farms. In the US a five year action plan for reducing antibiotics in farms has been implemented. Experts say the US is lagging behind Europe.

There is huge data to prove the link the use of antibiotics on farms and the rise of superbugs in hospitals. But farmers are resisting reform. Because the rise of superbugs is seen as a ‘hospital issue’, farmers can get away with ‘passing the buck’.

The rise of superbugs is not just killing people with infections, but making the use of chemotherapy more risky. In India cancer patients are dying from infections caused by chemotherapy that just can’t be cured. This could become common. You might be asked to choose between dying of cancer or from infections caused by superbugs that might kill. 

Everyone carries a large number of bacteria. In an immunocompromised patient this can kill. 

New antibiotics are not being invested in, by the pharmaceutical industry, due to rising costs of development. The global economy is predicted to lose 100 trillion dollars in economic output by 2050 due to this issue.

However, if we spent 42 billion over a decade in new farming techniques and developing new antibiotics, we could avoid this crisis. The return on investment on new procedures and new treatments is huge.

In England antibiotic use on farms has decreased 40% over four years. Internationally, drug resistance is being discussed at top levels. Money is being spend and the media are reporting on the issues. Hospital patients are dying of infections that could once be easily cured.

As superbugs have adjusted to our treatments we need to adjust to the epidemic of antibiotic resistance drugs.

The Austin hospital in Melbourne is going back to simple procedures that were once used to kill bacteria, like using bleach for disinfectant and isolating patients who have superbugs.

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