(MENAFN- Khaleej Times) The threat of the 'superbug', which is resistant to antibiotic, is real... And the UAE, like other countries, is seeing a rising trend in hospital-acquired infections that claim thousands of lives worldwide each year.
In May, reports from the United States said that it was the end of the road for antibiotics. Medical experts in the UAE agree and say that it will not take long for the bug - that is not killed by any antibiotic - to travel to the UAE. The report published in the Antimicrobial Agents and Chemotherapy magazine said that researchers found a person in the US carrying bacteria resistant to antibiotics of last resort (Colistin). Are doctors prescribing antibiotics unnecessarily? Experts say that while physicians are prescribing antibiotics unnecessarily, patients are popping pills without the right prescriptions. "Physicians are under pressure from patients. They feel that if they don't prescribe the antibiotic, they will be blamed if something goes wrong later," Dr Ashraf said. According to studies, although non-prescription sale of antibiotics is illegal in the GCC states, 68 per cent of pharmacies in Abu Dhabi, 78 per cent in Riyadh and 87 out of 88 pharmacies in Saudi Arabia sell them without a prescription. Researchers have also found that poor hand-hygiene compliance in hospitals and the region's large population of migrant workers could have contributed to the spread of antibiotic-resistant bacteria. "Other doctors think that starting a super strong antibiotic is necessary for patient betterment," he said, adding that physicians should do a risk assessment for patients, investigate and then prescribe. Dr Laila said: "Unfortunately antibiotics are being prescribed wrongly by the physicians or under pressure from the patients." "Another common mistake is incomplete courses of antibiotics, so the patient might take two or three doses of antibiotics and as soon as she/he feels better, they stop the antibiotic without going back to the prescribing physician." "This will obviously lead to the creation of drug resistance and there is a cumulative risk every time an antibiotic is used or prescribed inappropriately," she added. Dr Laila said that the situation was scarier when it came to drug-resistant bacteria in hospital. "Admitted patients have more serious illnesses. In these patients, a simple pneumonia or urinary tract infection can be a terminal event if we lack the proper antibiotic that can control the infection as early as possible. This can be complicated further if an outbreak of infection with these bacteria takes place in the hospital." The discovered germ E.coli was one of the most common ones, but tests showed it was resistant to first-line antibiotics - those usually used for these infections. The authors wrote that the discovery 'heralds the emergence of a truly pan-drug resistant bacteria.' Though such infections mainly affect hospitalised patients, experts say that the bacteria can also travel out of hospital settings and cause a disaster. "We should definitely worry about this bug," said Dr Ashraf ElHoufi, head of the Hospital Infection Control Committee at Dubai Hospital in an interview with Khaleej Times. The expert said that the E.coli bacteria could travel to the UAE 'within a short time.' "In 2010, the New Delhi bug (NDM1) was in the UAE within a couple of months, not because of the number of Indians here, but due to globalisation," said Dr Ashraf who is also consultant, ICU at Dubai Hospital. According to him, if an antibiotic is not used for some time, germs forget it. "The report shows that the bacteria became resistant to (colistine), which is not a very good antibiotic but this is the only one remaining," said Dr Ashraf. He said: "Currently, we don't have a colistine-resistant organism or a pan-resistant bug in the UAE but we do have a lot of resistant organisms here. "Every day we receive reports about organisms that are resistant to 15 or 16 different antibiotics from five or six different classes. These are multi-drug or pan-drug resistant organisms. Basically we are inventing new terms to describe organisms that are already present." Dr Laila Al Dabal, head of infectious diseases unit at Rashid Hospital, said that 'superbug' is not a medical term. "Healthcare professionals call it multi-drug-resistant bacteria. This implies that these bacteria will not respond to a number of commonly prescribed antibiotics." She said that the threat was global. "We are a facing a threat that does not respect boundaries and can be transmitted within hours from one country to the other. "In the Middle East, Gulf countries and the UAE, there has been a rising trend of drug-resistant bacteria reflecting the overall global picture over the last few years," she explained. "This has been taken seriously by health ministries and measures have been put in place to limit the problem including legislation, controlled prescription of antibiotics, guidelines and recommendations regarding optimal use of antimicrobials as well as controlling prescription of some powerful antibiotics to certain conditions only and by authorised physicians only," she said. Controlling infection Antibiotic resistance is unavoidable but it can be controlled to some degree with proper use of antibiotics by prescribing physician and patients. He advised people visiting a family member in hospital to ask medical staff if there is an infectious agent that can be transmitted and what precautions should be taken. "Normally, the patient is placed in an isolated room with a warning sign." The hospital also has an antibiotic monitoring committee for physicians. "We monitor prescriptions on a daily basis and send a feedback to doctors on the appropriateness of their selection," said Dr Ashraf, adding that the medical staff is required to abide by these guidelines or send a justification for drug usage. "This is improving the way we are prescribing. We are tracking and training." According to Dr Ashraf, measures to stop spread of superbugs in the UAE are adopted from international guidelines. "Yet the speed by means of which bacteria are evolving, mutating and developing resistance is much faster than our compliance with the guidelines and protocols to combat the problem." "Bacteria are becoming resistant very easily and very quickly. They can give their resistance to another set of bacteria, so certain resistance is transferred from one bacteria to the other." He also explained that under the continuous pressure of antibiotics, bacteria resistance will continue. "We call it a collateral damage. Whenever you use an antibiotic, some of the bacteria are inherently resistant and survive. When these surviving bugs multiply, they create a generation of resistant organisms." Dr Ashraf said inevitably the chronically, terminally and severely ill will die with one of these bugs. "It may not be the cause of death, but will be eventually the last stroke." Bugs mostly affect the elderly and patients with multiple co-morbidities such as diabetes and renal failure or those in chemotherapy or radiotherapy. Dr Laila said another challenge is the mismatch between the growing serious resistance and the number of new antibiotics being introduced into the market. "This will make it difficult for the managing physician since a few options (antibiotics) are left and some of these carrying high rates of toxicities and side effects." To stop spread of such bacteria in Dubai hospitals, a number of steps have been taken. "If the patient has any signs of infection, we investigate. If that organism is documented, we implement isolation measures. We try not to treat the organism unless it is causing infection," said Dr Ashraf. "In too many cases, the organism is just sitting there, colonising or contaminating the patients and doesn't need treatment. By adding an antibiotic, we are creating more collateral damage." People visiting the hospital carry the bug with them and unconsciously spread it. "If you are healthy, the superbug cannot attack your immune system," said Dr Ashraf. Surveillance system A surveillance system between Dubai Hospital and Rashid Hospital as well as the private and government hospitals has been activated. "We are also trying to get the microbiology surveillance system in place so we can publish a report on the level of resistance in Dubai Hospital and Rashid Hospital." Dr Ashraf said that the real threat is with limited supply of antibiotics. "All efforts should be taken to minimise further loss. Even if newer and more potent antibiotics are introduced into the market, we will keep losing them as we are not changing our attitude. We need to adopt an antibiotic awareness culture to preserve them for the coming generation."
Asma Ali Zain Associated with KT for 15 years. Covers health issues, Pakistan community, human interest stories as well as general topics for daily news or features.