Resistant bacteria clearly aren’t a fad, but how should one react, and what can one do? We asked Bertil Kaijser, professor in Clinical Bacteriology. He is working as MD at Sahlgrenska University Hospital in Gothenburg, in the hospital’s bacteriological laboratory regarding diagnostics, research, development and education.
From your perspective, how have you experienced the development of resistant bacteria?
Working in the lab, our staff notice this on a daily basis. We analyse numerous samples and every now and then we discover resistant bacteria. The amount of resistant bacteria is undoubtedly increasing, but the development in Sweden is slower than in many other countries. The latest development is that some bowel bacteria (ESBL) have developed the capability to break down penicillin. Other bacteria, such as MRSA, have been on our radar and combated for quite some time.
What’s causing the development?
It is mainly fuelled by the overuse of antibiotics, both within human and veterinary medicine.
Does the issue of resistant bacteria get enough attention in society?
In many parts of the world there is a pretty well-balanced common knowledge on the matter. The majority used to be unaware of the situation, but now quite a few know what it is and can act accordingly. Today in Sweden patients don’t expect as often to be prescribed antibiotics for a regular cold - something that was quite common a few years ago. Media is covering this story more frequently, and knowledge provides the opportunity to draw proper conclusions and act rationally.
What about regional differences?
No country can say that it has closed its borders to resistant bacteria. In a global world where travelling is common, people and bacteria, cross borders all the time. Some countries and authorities have adopted more restrictive approaches towards prescribing antibiotics, which is an effective measure in combating resistance. Other countries are less restrictive, for example mixing antibiotics into animal feed.
As with many other issues poor countries are at a disadvantage and are more vulnerable. Often it is possible for them to acquire and use antibiotics, but they lack the know-how and organization to tackle this issue. Regional conditions, such as the number of people living together, are also important. Infections are spread more easily in crowded areas.
What can be done?
This won’t be solved by introducing just one measure. As long as we live in a society which uses antibiotics, this risk will exist. Within healthcare we take very specific measures, e.g. if a patient at our hospital has been hospitalized abroad we always test to exclude MRSA and provide single rooms until an MRSA-infection is excluded. Authorities and organizations are working to spread the word and provide information. Just as important, they are also monitoring the current situation in order to develop and suggest action programs to authorities and health care. Even minor adjustments can be of great significance, such as making routines and products more accessible. Placing dispensers and washing stations in one’s line of sight makes it easier to facilitate good hygiene. Unnecessary overuse of anti-bacterial products is also important to avoid. For example, there is no purpose in anti-bacterial toothpaste. Each and every one of us have our own bacterial flora, and we shouldn’t try to get rid of it. We are going to carry it with us for the rest of our lives.
Should one be afraid?
Act with respect, yes. Be scared, no. We have about 1,5 - 2 kilos of bacteria in our bodies. They are our friends and we need them. Sometimes I meet people with a “if I could only get rid of all the bacteria, my body will be kept safe” attitude. That’s absurd. My advice is to carry on as usual. One can’t walk around all day being afraid of MRSA or ESBL, such fear can’t be channelled into something constructive. For people working at hospitals the requirements are different, as we constantly interact with people who are sick. We need to follow certain procedures and keep this in mind.
Do resistant bacteria add new hygiene requirements?
It’s always relevant to consider hand hygiene; using alcohol sanitizers and washing hands. Resistant bacteria are removed by washing just as easily as any other bacteria. And resistant bacteria, such as ESBL and MRSA aren’t more aggressive than other bacteria, it’s just that traditional antibiotics won’t work; the selection of antibiotics to treat the infection is smaller.
When working in environments, such as hospitals, where you need to wash your hands very frequently, alcohol rubs are easy on the hands. But otherwise regular washing with soap and drying with paper towels is effective and includes a mechanical element to the cleaning that reduces the amount of bacteria effectively. One thing to consider in terms of infections is the so called infectious dose, i.e. the amount of bacteria required to get an infection.
This dose is different from bacteria to bacteria, and can vary from just a few to several millions. Maintaining good hand hygiene frequently and properly, reducing the amount of bacteria and viruses on your hands, means you may reduce the risk of spreading infections.