The bacteria resisting last-resort antibiotics


enterococci

A report on the spread of antimicrobial resistance in Australia shows specific types of bacteria are a major emerging healthcare problem

One bacteria type in particular is causing resistance to last-resort antibiotics in just over half of hospital samples.

Despite some recent gains in efforts to encourage more careful use of antibiotics, the new report finds as much as 56% of samples of enterococci can be resistant to the antibiotic vancomycin – a level higher than in any European country.

The comprehensive national report, Antimicrobial Use and Resistance in Australia 2017: Second Australian report on antimicrobial use and resistance in human health, also finds that a strain of methicillin-resistant Staphylococcus aureus (MRSA) has become the most common type of MRSA infection in the community, and is now a more common cause of bloodstream infections than hospital-associated strains of MRSA.

The report will be launched at an event at Sydney’s St Vincent’s Hospital today by the Australian Commission on Safety and Quality in Health Care.

The report finds that antibiotic use has been falling in Australian hospitals, a shift that will help to slow the spread of resistance.

However, there are still concerning levels of inappropriate prescribing of antibiotics in hospitals and the community.

Antimicrobial use in the community is still “very high,” the report says.

“Australia’s antimicrobial prescribing rate is the eighth highest among member countries of the Organisation for Economic Co-operation and Development, and is more than double that of countries that prescribe the lowest rate of antimicrobials.”

Drawing on data from the Australian Government Department of Human Services pharmacy claim records of prescriptions dispensed under the PBS and RPBS and the Drug Utilisation Sub Committee database, the report found that in 2015, 44.7% (n=10,701,804) of the Australian population had at least one antimicrobial dispensed under the PBS/RPBS.

Of these, 18.5% had one antimicrobial dispensed, and 3.2% had more than six, including repeats.

Extended-spectrum penicillins were the largest group by number of prescriptions dispensed in 2015 (21% of scripts) followed by first-generation cephalosporins (20%) and penicillin-ß-lactamase inhibitor combinations (18%).

The most commonly dispensed antimicrobials accounted for 84% of all antimicrobial use in Australia in 2015.

Antibiotics were most often dispensed in community settings for very young people, and older people: in 2015, 15% of those aged 0-4 years, 60% of those aged 65 years or over and 76% of those aged 85 years or over were supplied with at least one antimicrobial.

Use in all age groups is higher in winter months.

 

The report also highlights several areas for action to help reduce antimicrobial resistance.

These include continued monitoring of the spread of resistant strains of Neisseria gonorrhoeae, the bacterium that causes gonorrhoea, to inform treatment guidelines for the condition.

In the case of vancomycin-resistant enterococci, the report calls for strict adherence to infection control guidelines and effective cleaning and sterilisation in healthcare facilities.

Commission Senior Medical Advisor Professor John Turnidge says antimicrobial resistance is “one of the most significant challenges for the delivery of safe, high-quality health services, and has a direct impact on patient care and patient outcomes”.

“AURA 2017 provides clinicians and health policy makers across Australia with the data and information needed to develop and better target strategies which will prevent and contain resistance, ultimately benefiting patients in our hospitals, and residents in the community and aged care homes,” Professor Turnidge says.

“Antibiotic resistance is greatly exacerbated through the overuse and misuse of antibiotics.

“Bacterial infections that were once able to be cured with antibiotics are becoming much harder to treat.

“In 2015, over 30 million prescriptions for antimicrobials were dispensed in the Australian community.”

The Australian Government Chief Medical Officer, Professor Brendan Murphy, says the development of nationally coordinated surveillance of antimicrobial resistance and antimicrobial usage is a key objective of the strategy.

 

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