The rising numbers of antibiotic-resistant bacteria are jeopardising lives. - 123rf.com
SINGAPORE: The Republic is reviewing its action plan to better control the emergence and spread of future drug-resistant superbugs.
The National Strategic Action Plan (NSAP) was launched in 2017 to reduce the antimicrobial resistance rate (AMR) here – meaning the prevalence of drug-resistant infections – through education, surveillance, research, infection prevention and control, and optimisation of antimicrobial use.
Currently, the country’s AMR rate for a number of infections such as the one caused by the drug-resistant E. coli and the Methicillin-resistant Staphylococcus aureus (MRSA) infection is lower than the global rate according to data submitted to the World Health Organisation (WHO).
On Oct 13, WHO had sounded the alarm over soaring numbers of drug-resistant bacterial infections, which compromise the effectiveness of life-saving treatments and render minor injuries and common infections potentially deadly.
The United Nations’ health agency warned that one in six laboratory-confirmed bacterial infections worldwide in 2023 showed resistance to antibiotic treatments.
The global rate for E. coli resistance to third-generation cephalosporins – broad-spectrum antibiotics – in bloodstream infections is 44.8 per cent, while in Singapore it is almost half of that at 23.8 per cent.
When it comes to MRSA, its global AMR rate is 27.1 per cent; it is 23.6 per cent in Singapore.
Though the local AMR rate is low and generally stable since 2019, antimicrobial resistance still poses a threat and “we must continue our fight against it,” Associate Professor Teoh Yee Leong, Group Director (Communicable Diseases Collaborations) of the Communicable Diseases Agency (CDA), told The Straits Times.
“In acute care settings, the incidences of some drug-resistant pathogens have declined over the years, while the incidence of (others) has increased slightly,” he said.
CDA is working with hospitals to further lower AMR rates, and with doctors and pharmacists to raise awareness in the community.
All hospitals in Singapore have antimicrobial stewardship programmes (ASP), which guide doctors how to use antibiotics to treat infections wisely, choosing the right drug, dosage and duration of treatment.
Adjunct Associate Professor Shawn Vasoo, Executive Director, National Centre for Infectious Diseases (NCID), told ST that even a “healthy microbiome” – or good bacteria – can cause disease because they constantly evolve and become resistant to antimicrobials they are exposed to.
“This phenomenon transcends the acute hospital setting and also takes place in the community,” he said.
“There are limited treatment options, and sometimes combination therapy has to be used (with several antibiotics) which may increase side effects. There are some newer antibiotics that can work against the ‘superbugs’ that have acquired resistance to our older antimicrobials.”
Both NCID and Tan Tock Seng Hospital screen patients, especially those with repeated hospitalisation, to see if they carry antibiotic-resistant organisms and if they test positive, the two institutions use special precautions, such as gowns and gloves or place them in single-rooms.
Dr Angie Pinto, an infectious diseases consultant at Woodlands Health, said: “We know that antibiotic overuse drives resistance, so we closely monitor the appropriateness of antibiotic use. Just under half (47 per cent) of patients (admitted at Woodlands Health) are on at least one antimicrobial while in hospital.”
She added: “We have pharmacists and infectious disease specialists reviewing antibiotic use daily, to prevent unnecessary usage. Our hospital has implemented a programme to re-evaluate the accuracy of antibiotic allergy labels in patients on broad-spectrum antibiotics, facilitating appropriate antibiotic choices in patients with mislabel allergies.”
Dr Amandip Sahota, Director of Antimicrobial Stewardship Programme at the Khoo Teck Puat Hospital, told ST that although new antibiotics are being developed, there are currently not many options to treat the most resistant of bacterial infections.
“The ones that are available are very expensive, often costing hundreds or even thousands of dollars per day, on top of the financial burden of a longer hospital stay. Preventing the development of resistant bacteria is still key,” he said.
“Beyond our local hospital interventions, we participate in national surveillance, data sharing, and policymaking for multidrug-resistant infections and antibiotic prescribing and usage.”
Dr Nares Smitasin, a senior consultant in infectious diseases at the National University Hospital (NUH) said the hospital takes a proactive approach “by creating clear treatment pathways for complex infections, enabling clinicians to choose the most effective therapy from the outset”.
Citing penicillin allergy as often over-reported, he said fewer than 10 per cent of patients who believe they are allergic to penicillin truly are.
“Our evaluation protocol helps clarify these allergy histories, allowing more patients to safely receive penicillin-based antibiotics, the most effective and least resistance-inducing options – while reducing unnecessary use of broader alternatives,” he said.
On antibiotic use, Dr Smitasin said while antibiotics are commonly used to prevent infections after surgery, “extending it unnecessarily after surgery does not reduce infection risk and can actually increase resistance”.
He added: “Our goal is to ensure antibiotics remain effective for future generations while maintaining the highest standards of care and patient safety today.”
“Tackling AMR requires more than the efforts of hospitals, the public or even by one country alone. Singapore works closely with Asean and international organisations such as WHO, World Organisation for Animal Health, Food and Agriculture Organisation and United Nations Environment Programme to strengthen AMR control in the region and globally,” Prof Teoh said. - The Straits Times/ANN
