The battle against multi-resistant bacteria

Often, antibiotics that combat other bacteria effectively are left powerless against multi-resistant bacteria. As Philipp Jent, Head of Infection Prevention at the University Hospital of Berne, explains, the cause of the problem is also part of the solution – fewer antibiotics.

Text: Nicole Krättli; photo: iStock

Sanitas: What makes a bacterium multi-resistant?

Philipp Jent: Infections caused by bacteria can usually be treated effectively with antibiotics. However, some bacteria are resistant to many or even all groups of antibiotics. These bacteria are known as multi- or pan-resistant pathogens. 

How widespread are resistant bacteria?

Multi-resistant bacteria are common around the world and they've been increasing in number in recent years. The situation is somewhat more encouraging in Switzerland: the most severe multi-resistant bacteria, such as carbapenemase producers, are usually observed in people returning from abroad. These are intestinal or environmental bacteria that are resistant to a wide range of reserve antibiotics. However, slightly less resistant intestinal bacteria such as ESBL-producers are also found widely in Switzerland. What's more, in recent years we've seen a rise in the number of cases of vancomycin-resistant enterococci, another intestinal bacterium that shows resistance to most antibiotics. 

Are these resistant bacteria a man-made problem?

Bacteria are vitally important for us. Some of these bacteria naturally carry genes that show resistance to antibiotics. These resistant bacteria disappear in the mass of other bacteria. By taking antibiotics, we kill non-resistant bacteria. In this way, antibiotics give resistant bacteria a greater chance of survival and upset the bacterial balance.

What's the relationship between antibiotics and the increase in resistant bacteria?

European data shows that the problems encountered with resistant bacteria are worse everywhere where antibiotics prescription rates are high. Similarly, studies in France show that certain bacteria lose their resistance when particular groups of antibiotics are prescribed less frequently.

Are antibiotics prescribed too readily?

Unfortunately, yes. Antibiotics are one of the most important achievements in medicine. That's why we should look upon them as a valuable resource and only use them in very specific cases. A large percentage of the antibiotics that are prescribed are for infections not usually caused by bacteria. But the trend is moving in the right direction. In the past, antibiotics were handed out almost willy-nilly for throat infections. Nowadays, doctors are more restrained.

One problem is that the very place where people are infected with resistant bacteria is the hospital itself. 

In hospital, there are many ill people – which means, of course, that there are many people who urgently need treatment with antibiotics. Inevitably, therefore, some of the resistant bacteria are more commonly found in hospitals. On the other hand, hospitals go to great lengths to identify those patients who might be carrying resistant germs, to limit transmission, and thus to minimise the risk. 

How dangerous are Swiss hospitals? 

Swiss hospitals are very safe environments thanks to the efforts made to prevent the transmission of multi-resistant bacteria. Multi-resistant bacteria such as ESBL or MRSA, a resistant bacteria that causes skin infections, are just as likely to be found outside hospitals as inside them. Despite the precautions taken, however, it's possible that infections may be transmitted to highly vulnerable patients in this environment. That's why it's crucial for hospitals to stay vigilant because in the rare cases when transmission does lead to an infection, the treatment is complicated and can only be carried out by specialists.

What general measures are taken to prevent resistant bacteria in hospitals?

Bacteria of this kind are commonly transmitted by hand, so hospitals regularly run campaigns about the importance of washing hands. Swiss hospitals also maintain high standards when it comes to cleaning surfaces and preparing medical devices. Hospitals exchange information regularly via forums such as the SWISSNOSO National Centre for Infection Prevention. What's more, they screen patients who arrive from hospitals abroad. In other words, active efforts are made to hunt down multi-resistant bacteria. 

Is it risky to visit hospitals abroad?

Hospitals in Switzerland compare very well internationally. By the same token, this also means there's a higher risk that patients who've recently been treated in a hospital abroad are carrying resistant bacteria. For example, there was an outbreak in Northern Italy recently of the highly resistant yeast fungus Candida auris, which can cause blood poisoning and stomach infections.

What can we as individuals do to reduce the transmission of resistant bacteria?

In addition to the customary hygiene measures we've all become familiar with since COVID-19, it's also important that we think critically about the use of antibiotics.

What does that mean exactly?

Common examples of needless antibiotics prescriptions include infections of the throat or pharynx, middle ear infections and other infections of the upper respiratory passages. Patients suffering these illnesses should discuss with their doctor whether it's really necessary to take antibiotics. It's also not necessary to use antibiotics with suspected infections of the urinary tract. Antibiotic treatment should be as short as possible - often there's no need to finish the packet. However, the discussion needs to go beyond human medicine. Antibiotics are used frequently in agriculture and crop cultivation, too. It's even more important to show restraint in these areas. After all, we humans don't live in a vacuum – we co-exist alongside plants and animals. The more resistant they are, the greater the difficulties we humans will encounter. Antibiotics are a very valuable resource and we're all dependent on them when we suffer a severe infection. It's up to all of us, across the board, to make sure they maintain their effectiveness in future.