Antimicrobial resistance (AMR) has emerged as one of the most urgent public health threats facing Australia and the wider world.
Infectious Diseases Physician Dr Peter Simos is called into action when the usual treatment options available to doctors have hit a brick wall.
When a young woman presented to Gold Coast University Hospital in late February with a wound that had an abscess beneath it, it quickly became clear that the situation was complicated.
She had just received an abdominoplasty (tummy tuck) overseas.
After initial testing, the wound was found to be carrying four separate bacterial resistant mechanisms, which severely limited treatment options.
“All the standard antibiotic options came up as resistant,” Dr Simos said.
“So, a general doctor would look at that and go, ‘I literally have no traditional antibiotic treatment options left for this infection.’”
Because antibiotics alone weren’t working, she underwent surgery in early March to remove the infected tissue and had a skin graft.
After careful treatment to avoid any further infection, she is due back to the hospital’s plastics clinic in early April.
This case is an example of antimicrobial resistance (AMR), which has emerged as one of the most urgent public health threats facing Australia and the wider world.
AMR occurs when microorganisms adapt to withstand antimicrobial treatments like antibiotics.
It means infections caused by a virus, fungi, parasites or bacteria effectively become drug-resistant.
They remain in the body for longer or become difficult or sometimes impossible to wipe out with commonly used medicines.
The sixth Australian report on antimicrobial use and resistance in human health released by the Federal Government states that AMR played a role in more than 4.7 million deaths worldwide in 2021.
By 2050, that number is projected to soar to 8.2 million.
Antibiotics are the bedrock of modern medicine, but AMR can lead to something as simple as a small scratch or scrape becoming life-threatening.
Paediatric Infectious Diseases Specialist Dr Angela Berkhout said the spread of AMR was accelerated by the misuse or overuse of medicine, as well as poor hygiene and infection control.
While it becomes increasingly more common in countries without stringent health processes in place, Dr Berkhout said there was no doubt it posed a global health threat.
The overuse of broad-spectrum antibiotics is strengthening microorganisms’ resistance, which is leading doctors to reach for ‘last-resort’ options more often.
But even doing this creates issues.
“What we’ve got to consider in Australia is that some countries with severe AMR are our close neighbours,” she said.
“Research shows that in some areas, doctors have no antibiotics available to treat common bacterial infections in children. They were all resistant.
“If we fail to act, the worst-case scenario is where antibiotics no longer work and we’re transported back to a pre-antibiotic era.”
Dr Berkhout is based between the Queensland Children’s Hospital and the Gold Coast University Hospital, specialising in antimicrobial stewardship to slow down the spread of AMR.
She said the worldwide development of new antibiotics is not advancing quickly enough to keep pace with increased resistance.
Most relevant studies in this space are done in adults, making it tricky to extrapolate results and dosing into the paediatric population.
Dr Berkhout recounted a recent case involving an extremely premature newborn with a severe chronic neonatal lung disease and a severe infection.
“The newborn had a bloodstream infection and chest infection with a multi-resistant Pseudomonas infection. Due to the infection being multi-resistant, we had to reach for last resort antibiotics,” she said.
“Luckily this did the trick and the infection cleared. But, the concern is that we had to reach for the ‘last resort’ option so early.
“If we’re already using our last resort, what are we reaching for next time?”
Dr Berkhout said minimising overuse of antibiotics is a crucial step toward slowing down AMR.
This involves simple, everyday actions: keeping wounds covered until they heal, staying up to date with vaccinations and using antibiotics as instructed.
The responsibility for healthcare professionals includes considering alternatives to immediate antibiotic prescriptions, explaining AMR to patients and maintaining strict hygiene and infection control standards.
While Dr Simos noticed AMR was becoming more common in his day-to-day work, he said serious or critical cases were thankfully rare.
He echoed Dr Berkhout’s warnings about resistances present overseas after he saw firsthand how dangerous it could be.
The reality is that antibiotic resistance doesn’t respect borders.
Whether a patient is recovering from a motorbike accident that happened overseas or a minor wound at home, Queensland’s commitment to infection control and responsible antibiotic use is what will keep these ‘untreatable’ infections at bay.