In healthcare, superbugs refer to pathogens that are resistant to antibiotics. They are a daunting healthcare problem as they threaten lives with simple infections that would not heal.
The global healthcare burden posed by superbugs is known as antimicrobial resistance (AMR)—a condition where infectious microorganisms previously susceptible and responsive to a certain treatment become resistant to it.
In a recent healthcare forum, dubbed, “Fighting Multi-Drug Resistant Infections” held at Manila Diamond Hotel, the multi-stakeholder group composed of the Department of Health, Philippine College of Physicians, and global healthcare company MSD in the Philippines reiterated its commitment to fight AMR by espousing the country’s Antimicrobial Stewardship Program and development of new antibiotics.
An example of superbug
Superbug Pseudomonas aeruginosa was the focus of the event discussion as it is highlighted by the World Health Organization as critical priority pathogen that is resistant to multiple antibiotics.
Pseudomonas infections cause more deaths compared to other pathogens, and are highly-resistant to most types of antibiotics like carbapenem which is often referred to as “antibiotic of last resort.” It is the leading cause of pneumonia, the third top cause of urinary tract infections, and eighth leading contributor to bloodstream infections.
At risk of Pseudomonas infections are elderly patients, people being treated with antibiotics, diabetics, burn or immuno-compromised patients, residents of healthcare facilities, and those with previous histories of infection.
The Philippines, being a country in Southeast Asia, in more of a threat to at risk of being threatened by carbapanem-resistant Pseudomonas given that the prevalence in the region is from 31 to 50 percent.
Dr. Adrian Brink, founding president of the Federation of Infectious Diseases Societies of Southern Africa, described Pseudomonas as “the most sophisticated bug you can find in the hospital. The size of the DNA of Pseudomonas is double the size of E. coli.” He added, “The specie has many ways to overcome antibiotics and it can survive most harsh circumstances.”
“If I swab your kitchen or your bathroom or your car, I probably would find Pseudomonas,” revealed Dr. Brink. “If you flush the toilet, the spray from the toilet water can colonize a patient or, indirectly, through the hands of the doctor or nurse, or equipment like a stethoscope.”
How to fight this superbug
Getting rid of Pseudomonas requires a lot of effort and resources. According to Dr. Brink, one effective practice is washing of hands before and after touching a patient and when leaving the patient’s room. Many hospitals around the world also use ultraviolet light to decontaminate patient rooms.
Moreover, a novel anti-Pseudomonas cephalosporin, ceftolozane paired with tazobactam is now available as treatment for Pseudomonas infections. The drug was initially indicated for complicated urinary tract and intra-abdominal infections, but had a broader coverage of combating other disease-causing pathogens.
In the fight against AMR and Pseudomonas, the forum highlighted the crucial need to handle antibiotics with care. AMR is largely and often caused by misuse or abuse of anti-microbial drugs as it allows bacteria to develop immunity from antibiotics.
“Every prescription needs to be correct so that every patient is assured they are getting the right antibiotic, right dose, right route of administration, right timing, and right duration,” emphasized Dr. Regina Berba, head of the DOH Antimicrobial Stewardship Steering Committee and chair of the Philippine General Hospital Infection Control Unit.
She continued, “It’s only with this concept that we would be able to optimize patient outcomes, prevent the emergence of AMR, minimize adverse drug reactions, and reduce healthcare costs.”
The ASP involves strong surveillance and laboratory capacity for examining pathogens, access to essential medicines with assured quality, stewardship awareness promotion, and enhanced capability of health institutions in preventing multi-drug resistant infections.
“We started AMS training in 2017 and finished it for all level 3 hospitals. This year, we’re doing more of the level 2 hospitals and next year we hope to finish all 788 level 1 hospitals,” said Dr. Berba.
Members of the private sector also strengthened collaborative efforts with the DOH to fight AMR. Global healthcare company MSD in the Philippines, for instance, rolled out an eAMS application to 15 government and private hospitals that contained digitized, protocol AMS booklets to bring the advocacy closer to healthcare professionals and patients.