Antibiotic resistance in hospitals

In the first half of 2013, the UK's Chief Medical Officer, Dame Sally Davies described antibiotic resistant bacteria as a "ticking time bomb" which could make routine operations deadly in just 20 years. Kat Arney spoke with Dr Nick Brown, consultant medical microbiologist and lead infection control doctor at Addenbrooke's Hospital in Cambridge...

Nick - Well of course, antibiotic resistance is an entirely natural phenomenon and something that we could consider to be entirely predictable because bacteria had been around for tens of thousands of years.  Most of the antibiotics that we have today are products that were developed from naturally occurring substances in the environment.  So, bacteria have developed ways of overcoming their activity.  But if an organism is able to become resistant to an antibiotic then it won't respond to treatment with that agent.  Therefore, the outcome from infections is more severe.  People might not be able to go home from hospital for example.  They might stay in the hospital longer.  The results of the treatment might not be as effective and some things that we might consider to be common as part of everyday modern healthcare, for example, total hip replacement or cancer treatments might become impossible if we have no antibiotics to treat the infections that might complicate them.

Kat - Now is this a particularly recent problem or has it been going on for some time?

Nick - Antibiotic resistance was described very, very soon after the first antibiotics were developed.  But in fact, bacteria have had the ability to become resistant for far longer than that.  So, there have been studies in Canada on permafrost for example and studies on soil that was taken from around the roots of plants that were harvested in the 17th century that showed that the bacteria in these samples had genes that had a potential to confer resistance to antibiotics that are used today.  So certainly, the organisms have the ability to develop resistance very quickly.

Kat - Can you paint me a bit of a picture of the actual scale of the problem?

Nick - Well, it's very difficult to give just a single absolute number of course because the problem varies from organism to another and from one place to another, not only in the community and in the hospital, but also, from one country to another.  But if we take some specific examples for common infections that cause for example, cystitis or urinary tract infection, now, there are organisms that are resistant to all of the usual oral antibiotics that GPs in this country have available to them.  People are having to be admitted to hospital to have intravenous treatment.  In other parts of the world, common infections such as pneumonia or other chest infections can't be treated with the penicillin group of antibiotics because the most common organism that causes this infection, Streptococcus pneumoniae is becoming resistant.  So, it varies from one place to another, one organism to another.  But what is common I think across the whole patch is that resistance is becoming more common.  Not only that, of course, the other big issue is that we don't have any new antibiotics that are coming along to take the place of the ones that are becoming less effective.

Kat - We'll be covering later on in the show about some of the new approaches that people are taking, but I just wanted to explore maybe why we're seeing such a problem now.  Because you hear in the papers that it's because doctors have been giving out antibiotics like sweeties, how much has overuse of antibiotics led to this resistance challenge that we have now?

Nick - I think that it is certainly an issue.  If we think of the main strategies that we have for controlling resistance then clearly, making the use of antibiotics more appropriate is one key area to - if you like, protect what we've got.  But overuse of antibiotics is something that occurs very widely and perhaps also, in some respects, more important is the variation in antibiotic use, for example between one GP and another and between one country and another, and that's not easily explainable.

Kat - So, is this the kind of approach that we need to take across borders? Because I guess people travel so much, that we're just spreading infections all around the world?

Nick - Absolutely, this is key.  In some areas of the world, the problem is being taken much more seriously than in others.  That is one of the key issues that organisations such as WHO are taking very seriously at the moment.

Kat - If we don't take it seriously, if we don't properly get a lid on bacterial resistance, what are some of the costs that we could face?  You talked about making surgery very difficult, but in terms of the financial costs and human costs.

Nick - Absolutely in both and we forget, I think how much we've become to rely on antibiotics in all aspects of healthcare.  So, not only the traditional infections if you like - the chest infections, the skin infections, urine infections, but the treatment of cancers where survival has improved dramatically.  But the aggressive chemotherapy we now give people make them much more vulnerable to infection.  Bone marrow transplantation, organ transplantation, liver, kidney, heart, lung transplants for example would not be possible if you didn't have any antibiotics to treat the infections that occur after them.

Kat - And we're going to talk more about designing specific strategies, but broadly, what would you like to see happen very, very quickly to help get on top of this problem?

Nick - Well, in the introduction, we've already discussed the Chief Medical Officer's Annual Report and in that, to summarise, the two key areas of activity really, the first - to protect what we've got, to make better use of antibiotics to prevent the emergence of new resistance, and to prevent the resistance that is already occurring spreading more widely.  And then the second area is to try and regenerate the pipeline for drug discovery of new antibiotics because although there was a golden era of antibiotic development until about 1968 when 15 classes of antibiotic were discovered and developed.  Since then there have only been 5 classes of antibiotic discovered and in fact, you could argue that some of those were actually just modifications of ones that had been there before.