Waikato doctors prepare for increase in infections as antibiotics lose their effect Tuesday, 26 April 2016

Source: Stuff 24 April 2016

Within the next 10 years, a scratch from a rose thorn will kill people. A World Health Organisation report reveals antibiotic resistance is "no longer something that might happen - it is happening right now, across the world, and is putting at risk the ability to treat common infections", as from garden mishaps.

In the Waikato, hospital doctors have responded by increasing their infectious diseases team, expecting an increase in patients with infections resistant to antibiotics.And one Hamilton family has already been at the painful coal face of that prediction, after their daughter contracted Methicillin-resistant Staphylococcus aureus (MRSA), a superbug. It was antiobiotics that saved her, but it took months and she lost both legs in the process. When Hamilton couple Stuart and Bridget Meehan's 10-year-old daughter, Ava, was two, she developed croup, a viral infection common in children under the age of six. Her organs shut down, which caused her limbs to die. She also contracted a staph infection - Staphylococcus aureus - which spread to her lungs and into her blood system, causing septic shock.

She was on different courses of antibiotics for months to combat the infections. "They could never really prove where the staph infection entered, because it was an internal infection rather than an external," Meehan said."She got sick in May and didn't have the amputation until August, so she was in hospital and on antibiotics the whole time. She had all these lines and feeding tubes and all that."The Meehans spent 14 weeks at Starship Children's Hospital and Ava was allowed to return home just before her third birthday, when she received her first wheelchair and prosthetics. 

"We were lucky that she bounced back and we didn't have any problem with infection after the amputation, but we met one family in hospital who had been there for a year for an infection their boy received because of a prick from a rose thorn," Meehan said."We absolutely credit antibiotics for keeping her alive, it's amazing what they can do. So to think those same medications that helped Ava may not be able to help others in the future is shocking."The WHO report says that without urgent action, the world is headed toward a post-antibiotic era, where common infections and minor "injuries that have been treatable for decades will once again kill."

In a documentary for Prime called Peak Antibiotics, Dr Deborah Williamson, of the Institute of Environmental Science and Research (ESR), said that era will be seen within 10 years."We're in a war against very smart bugs, against bacteria with billions of years of evolution on their side, which have built a resistance to every single class of antibiotics that we have thrown at them," Williamson said."What we're facing in New Zealand is a man-made public health crisis. To say we could go back to an era where people die of common diseases is absolutely correct."Professor Gregory Cook, of the University of Otago, said the more antibiotics are used, the more resistance is created."It's at a certain point where we have so much resistance to the antibiotic that you may as well throw it out," Cook said."If we get to a point where we don't have antibiotics, that will be a terrible day, because we'll have disease in humans and animals where there is no cure. And for some of those diseases, that will be a very slow death." 

Waikato Hospital consultant for the infectious diseases team Dr Paul Huggan deals with 20 to 30 patients a week with common and complex infections. An example of a complex case would be a bone infection. Staff will typically see those patients fortnightly for three to six months.The team recently increased its staff and resources, including offering specialist advice to staff in Thames Hospital via video conference calls to manage patients in the Hauraki area."Here at Waikato, because we have a large number of patients living in rural Waikato, there are occupational hazards," Huggan said."So leptospirosis - it's a common infection for sheep farmers - and typhus from mice.

Duggan said it's accumulated pressure of antibiotic use by the entire population that drives the evolution of organisms to become resistant - not so much individual use."So if I give you an antibiotic all your life, your gut will fill up with bugs that are able to grow in the presence of that antibiotic. And that's the basis of antimicrobial [bacteria, fungi, viruses and parasites] resistance."The bugs can talk to each other. It's like a viral Facebook post. Once a bug learnt how to be resistant, its brothers and its sisters learnt how."There are certain circumstances where we worry about certain individuals overusing antibiotics, but if you had a chest infection last year and used the same antibiotic to treat another chest infection this year, we would expect it to work again."Huggan said part of the problem is the the overuse of antibiotics as a population and in some places in Asia, antibiotics are available over the counter without a prescription.

Most tertiary hospitals will have a third to a half of their patients on antibiotics. The last audit done at Waikato Hospital showed 40 per cent of patients were on an antibiotic or had used one within the previous 24 hours."The real threat is the organisms which are now present in many parts of Asia and the United States which are really resistant to any clinical antibiotic," Huggan said."Those bugs tend to affect our sickest patients, like those in intensive care and rest homes. The cost to the individual patients and also to the hospital if we are unable to treat those would be quite substantial.

"It's inevitable that these [antibiotic-resistant] bugs will arrive here, but it is unsure in what quantities and how. These are the unknowns for us and despite efforts to control the spread of these bugs, they will become established in the population as a whole and if and when that happens, those organisms will cause extreme disease and when people get sick, you could say expanding the bedrock of expertise is helping plan for that future."