Antibiotic resistance – A global health crisis

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Sunday, 04 September 2016
20:30 – 21:30 SAST (14:30 EST, 19:30 BST)
Moderator: Vanessa Carter
Hashtag: #hcsmSA

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The Story of ONE HEALTH
During 2014, the World Health Organization reported that antibiotic resistance “is now a major threat to public health,” and warned of a return to a pre-antibiotic era, where “common infections and minor injuries which have been treatable for decades can once again kill.” World health leaders have described antibiotic resistant microorganisms as “nightmare bacteria” that “pose a catastrophic threat” to people in every country in the world.

Antibiotics were introduced in the 1940’s and today are central to modern healthcare. They are used for treating patients with serious infections to preventing infections after surgery, protecting cancer patients and people with compromised immune systems, and promoting growth and preventing disease in livestock and other food animals.

Decreasing antibiotic effectiveness is a global threat, regardless of a country’s income or the sophistication of its healthcare system. Some pathogens are resistant to more than one antibiotic, and new, last-resort antibiotics are expensive and often out of reach for those who need them.

Antibiotic resistance is a direct result of antibiotic use. The greater the volume of antibiotics used, the greater the chances that antibiotic-resistant populations of bacteria will prevail.

Antibiotic Resistance: A Public Health Crisis | Victoria J. Fraser, MD | TEDxStLouisWomen
The story of ONE health

 

What is being done about antibiotic resistance?
The US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) have launched initiatives to help address antibiotic resistance. The FDA has issued drug labelling regulations and recommends judicious prescribing of antibiotics by health care providers.

The FDA is also encouraging new and ongoing research into effective antibiotic regimens, vaccines and diagnostic tests. However, antibiotic resistance is a global epidemic that everyone – health care providers, patients and caregivers – can help to prevent.

Article reference: What can you do to help prevent Antibiotic Resistance


Antibiotic Resistance directly affects these other conditions which pose a substantial public health threat globally:

  • Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
  • It is an increasingly serious threat to global public health that requires action across all government sectors and society.
  • Antimicrobial resistance is present in all parts of the world. New resistance mechanisms emerge and spread globally.
  • In 2012, WHO reported a gradual increase in resistance to HIV drugs, albeit not reaching critical levels. Since then, further increases in resistance to first-line treatment drugs were reported, which might require using more expensive drugs in the near future.
  • In 2013, there were about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB). Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 100 countries. MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB.
  • In parts of the Greater Mekong subregion, resistance to the best available treatment for falciparum malaria, artemisinin-based combination therapies (ACTs), has been detected. Spread or emergence of multidrug resistance, including resistance to ACTs, in other regions could jeopardize important recent gains in control of the disease.
  • There are high proportions of antibiotic resistance in bacteria that cause common infections (e.g. urinary tract infections, pneumonia, bloodstream infections) in all regions of the world. A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus(MRSA) or multidrug-resistant Gram-negative bacteria.
  • Treatment failures due to resistance to treatments of last resort for gonorrhoea (third-generation cephalosporins) have been reported from 10 countries. Gonorrhoea may soon become untreatable as no vaccines or new drugs are in development.
  • Patients with infections caused by drug-resistant bacteria are generally at increased risk of worse clinical outcomes and death, and consume more health-care resources than patients infected with the same bacteria that are not resistant.

 

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Why does storytelling matter to ICT innovation and to identify gaps?
I am recognised as a Facial Difference advocate by most of my colleagues, in 2004 I had a severe car accident that caused damage to my face. What most people don’t know is that during my ten years of surgeries I developed an Antibiotic-Resistant Bacteria known as MRSA (Methicillin-Resistant Staphylococcus Aureus). I had several prosthetic implants to restore the facial appearance, one of these was a 3D-printed Alloplastic prosthetic. There was so much excitement in 2009 between the doctors and I because of this emerging technology, I was in awe of the possibilities as I held a life-like printed replica of my skull before surgery, however, several weeks later my body rejected the implant and I developed a complex infection. We had to perform multiple surgeries in an attempt to salvage it but the damage caused to my face from infection was so severe that the prosthetic had to be removed and I was set back by several years.

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I was fortunate that the bacteria had colonised on the implant and not entered into my bloodstream which could have been fatal. I questioned how this had happened to me and wondered whether there could have been better resources available to empower me to manage my MRSA better. One obvious resource I had limited access to was reliable education.

Once my surgeries were complete, I became an ePatient speaker and shared my story in Paris at The Doctors 2.0 and You conference. I am also an advisor to Infection Control tips and I recently participated in the European EyeforPharma Summit in London in a panel discussion to help identify ways to improve clinical trial recruitment. I am not a doctor or a pharmacist,  I am a concerned citizen who is no longer able to rely on antibiotics. Stories won’t change the crisis, but they can help to identify issues in the system to improve prevention measures.

These were some of my challenges from a patient perspective:

1. The “complete the course” sticker
The antibiotic boxes only had a small “complete the course” sticker and the inserts were not patient-friendly, nor did they address barriers such as literacy and language differences
2. Lack of support
The first people I turned to for advice were my pharmacists, nurses and doctors, but some of them were not versed enough to educate me about MRSA.
3. Limited access to online advice
Pharmaceutical companies consumer services were not efficient at answering my concerns. Real-time support online would have been valuable.
4. Vague, ambiguous marketing
Hospital posters were not directly informative as to how and why antibiotics are causing superbugs. Some were designed with very vague messages which only emphasised to complete a course. Many of the public hospitals do not have central education channels or websites which would be useful to patients finding resources as opposed to searching widely on the internet. Animated videos with audio in different languages would address many barriers. Medication packaging and dispensaries are also an important contact point for consumer education, we should re-design inserts so that they are patient-friendly, but also brand the outer packaging with associated risks.
5. Communication gaps between multi-disciplinary teams
My facial reconstruction required a multi-disciplinary team, they worked in silos and each referred me to the other. There were gaps in communication and extended waiting periods between appointments, as a result I was prescribed antibiotics several times concurrently and not tested for MRSA, even though the infection was worsening. It was difficult for me to hold a single doctor accountable afterwards, one or two of them shifted the blame to the other.
6. Delay in testing for MRSA
I was only tested for MRSA after the prosthetic implant had been removed. Testing should be done before a course of antibiotics begins.
7. Limited knowledge to self-care 
I was never sent home with instructions to self-care. Simple instructions like how to sterilise my counter at home while doing my dressing or washing my hands. Some mobile apps suggest they provide care assistance to report regression in real-time to the physician, that would also be useful.

hcsmSA - antibiotics header


Patient rights and responsibilities 
According to the HPCSA patient’s rights ethical guidelines:
“Patients have the right to informed consent”
– which means that everyone has a right to be given full and accurate information about the nature of one’s illnesses, diagnostic procedures, the proposed treatment and risks associated therewith and the costs involved”.

Does that mean I need to understand the risks associated with treatments like antibiotics? I’ve never had a doctor explain the risks of mutation and superbugs. If it is my responsibility as a patient to take care of my own health, how can I do that if I am not empowered with information? Explaining key facts like mutations enable me to understand why I must “complete the course”.

In a recent article, it was suggested that reducing antibiotic consumption, can be achieved by improving public health and sanitation in lower- and middle-income countries that lack public health infrastructure, a target that can be linked to UN Sustainable Development Goals. But they also call for public campaigns, aimed at both physicians and patients, to discourage the inappropriate use of antibiotics.

As we enter into eHealth in South Africa, how we can meaningfully improve this situation?

 


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World Antibiotic Awareness Week 2016
14-20 November 2016

What can citizens do to improve Antibiotic Resistance?

People can help tackle resistance by:

  • hand washing, and avoiding close contact with sick people to prevent transmission of bacterial
  • keeping vaccinations up to date;
  • using antimicrobial drugs only when they are prescribed by a certified health professional;
  • completing the full treatment course (which in the case of antiviral drugs may require life-long treatment), even if they feel better;
  • never sharing antimicrobial drugs with others or using leftover prescriptions.

 

 

Health workers and pharmacists can help tackle resistance by:

  • enhancing infection prevention and control in hospitals and clinics;
  • only prescribing and dispensing antibiotics when they are truly needed;
  • prescribing and dispensing the right antimicrobial drugs to treat the illness.

Policymakers can help tackle resistance by:

  • improving monitoring around the extent and causes of resistance;
  • strengthening infection control and prevention;
  • regulating and promoting appropriate use of medicines;
  • making information widely available on the impact of antimicrobial resistance and how the public and health professionals can play their part;
  • rewarding innovation and development of new treatment options and other tools.

Policymakers, scientists and industry can help tackle resistance by:

  • fostering innovation and research and development of new vaccines, diagnostics, infection treatment options and other tools.

WHO’s response

WHO is guiding the response to antimicrobial resistance by:

  • bringing all stakeholders together to agree on and work towards a coordinated response;
  • strengthening national stewardship and plans to tackle antimicrobial resistance;
  • generating policy guidance and providing technical support for Member States;
  • actively encouraging innovation, research and development.

guests


ANDREW DUOUNGAndrew Duong
With over 8 years of research experience, Andrew co-founded InfectionControl.Tips, and serves as a director and its managing editor.

After obtaining his Bachelor of Science in Genetics, he earned a Master of Science in Microbiology from the Michael DeGroote Institute of Infectious Disease Research at McMaster University. In addition to his role, Andrew also serves as a research coordinator in the department of surgery at Hamilton Health Sciences.

InfectionControl.Tips are a partnering initiative for the upcoming KNOWLEX, UK (www.knowlex.com) conference tackling antibiotic resistance on a global level.


MARCMENDELSOHNProf. Marc Mendelson
Professor of Infectious Diseases at the University of Cape Town and head of the Division of Infectious Diseases and HIV Medicine.

Prof. Mendelson is the current president of the Federation of Infectious Diseases Societies of Southern Africa (FIDSSA), which is an umbrella organisation for six individual infection-related societies:
Adult Infectious Diseases (IDSSA); Paediatric Infectious Diseases (SASPID); Clinical Microbiology (SASCM), Infection Control (ICSSA); Sexually Transmitted Infections (STDSSA) and Travel Medicine (SASTM).

Prof. Mendelson is also the co-chair of the South African Antibiotic Stewardship Programme (SAASP).


0c29312Prof. Rodney Rhode
Dr. Rodney E. Rohde (@RodneyRohde) is Professor, Research Dean and Chair of the Clinical Laboratory Science Program (CLS) in the College of Health Professions of Texas State University, where he spends a great deal of time mentoring and coaching students in this sometimes mysterious and vague path. He has been recognised with teaching excellence at both Texas State and Austin Community College. Dr. Rohde’s background is in public health and clinical microbiology, and his PhD dissertation at Texas State was aligned with his clinical background: MRSA knowledge, learning and adaptation. His research focuses on adult education and public health microbiology with respect to rabies virology, oral rabies wildlife vaccination, antibiotic resistant bacteria, and molecular diagnostics/biotechnology.


halaHala Jawad
Practice Pharmacist, Community Pharmacist,
Royal Pharmaceutical Society UK moderator for public health network,
Royal Pharmaceutical Society UK Foundation champion
LPF steering group at RPS Surrey, advocate member for the RPS
Championing patient -centred consultation skills
Active on social media, Vlogger, IPharmacistUK


jamieDr Jamie Saris
Dr. Saris is a Senior Lecturer in the Department of Anthropology, National University of Ireland (Maynooth). He holds advanced degrees in Social-Cultural Anthropology from the University of Chicago (MA and PhD), and he has completed a Postdoctoral Fellowship in Clinically-Relevant Medical Anthropology in the Department of Social Medicine, Harvard Medical School (1992-1994). He has been working for more than fifteen years in medical and psychological anthropology in Ireland, North America, and parts of Africa, where he has researched and published on such diverse issues as the social life of mental hospitals, the experience of major mental illness, colonialism and its aftermath, poverty and structural violence, drug abuse, and HIV risk and treatment. He is the Co-Chair of the Combat Diseases of Poverty Consortium (www.cdpc.ie), and he was formerly the Deputy Director of NIRSA (National Institute of Regional and Spatial Analysis), a multi-disciplinary research centre of excellence (www.nuim.ie/nirsa/).


questions

 

Please start your answers with T1, T2, T3, T4 or CT for transcript purposes after the moderator (@hcsmSA) has prompted.

T1:What is causing antibiotic resistance?

T2: What diseases do they include? (e.g. AIDS, MRSA, C.diff)

T3.What can be done to improve antibiotic resistance?
(e.g. Stewardships, participation between stakeholders, patient education, sanitation, policy changes, washing hands, advocacy or relative to ICT innovation: mobile apps to improve adherence, better communication systems or websites)

T4. What is being done for pharmaceutical R&D to develop new drugs?

T5: What are the repercussions of antibiotic resistance not being controlled and monitored globally?

C.T. What closing thoughts would you like to add to this conversation?

 


hcsmSA are pleased to be moderating an eHealth panel discussion at the #WomenForumSA conference on the 9th – 13th of October in Johannesburg. Visit the Women Advancement Forum to read more. Tickets and sponsorship opportunities are still available.

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