Harder to beat stubborn infections

Proper enforcement is needed as antibiotics are easily available all over the country in many outlets. – 123rf.com

IT’S a worrying problem around the world, and for Malaysia too, as we are now faced with “superbugs” – stronger bacteria that are resistant to drugs.

These superbugs make it more difficult to treat infections, as patients take a longer time to recover, while being at higher risk of severe illness.

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In Malaysia, an example of bacteria which have become stronger is the Acinetobacter baumannii, which is responsible for illnesses like pneumonia, meningitis, bloodstream infections and urinary tract infections.

“Its resistance rate has increased for all antibiotics tested,” the Health Ministry tells Sunday Star.

“For an antibiotic known as meropenem, the bacteria’s resistance towards it jumped from 58.7% in 2020 to 68.8% last year.”

This means that there is a 68.8% chance that such an antibiotic won’t work on patients infected with the bacteria.

Another bug that has become tougher to kill is Klebsiella pneumoniae, which causes pneumonia and bronchitis.

“The bacteria’s resistance rate towards the cefuroxime antibiotic spiked from 25.7% in 2020 to 28.3% last year,” the ministry says.

As such, some infections are becoming tougher to treat in Malaysia nowadays. It’s a situation called antimicrobial resistance (AMR), where bacteria adapt over time and no longer respond to medicines. This makes the drugs ineffective, causing it to be more difficult for patients to recover and increasing the risk of disease spread and even death.

“The problem is accelerated due to the overuse of antibiotics – either in human medicine or in food production, like the livestock and aquaculture industries,” says the ministry.

It’s also caused by the spread of residues of these medicines and stronger bacteria in soil, crops and water.

“Resistance to antibiotics is now considered one of the most urgent global risks, requiring international and national attention from policymakers and the public,” the ministry says.

A recent study by the ministry also showed that a resistant form of the E.coli bacteria is widely circulating in humans, animals and the environment in Malaysia.

“The prevalence of the E. coli superbug among hospitalised patients with blood infections was high at 21.7%,” it says.

About 20% of healthy pregnant women in the study were also carriers of the superbug.

“This study also revealed a high prevalence of the bacteria among 240 samples of chicken (61.3%), likely due to the misuse or overuse of antimicrobials in chicken production,” the ministry says.

The E. coli superbug was also present in the environment, with the highest concentrations found in slaughterhouse wastewater, followed by communal wastewater and downstream rivers.

Fighting stubborn bugs

Other examples of infections that have become harder to treat are tuberculosis (an infection that usually attacks the lungs), gonorrhea (a type of sexually transmitted disease) and salmonellosis (food poisoning), says Dr Raj Kumar Maharajah, president of the Medical Practitioners Coalition Association of Malaysia.

“They are becoming more difficult to handle as the antibiotics used against them are becoming less effective. Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality,” he says.

Dr Raj Kumar explains that in cases where patients do not improve after being given one type of antibiotic, doctors will change it to stronger types.

“Some infections are self-limiting, meaning that they will get better with or without medication. But it will take more time if one were to go without drugs,” he adds.

Based on his observation, some patients with urinary tract infections nowadays take longer to heal: “Usually, it would take three to four days to clear. But these days, some patients take up to seven to 10 days to recover,” Dr Raj Kumar shares.

He says the AMR problem is made worse when there’s lack of clean water, sanitation and insufficient infection prevention.

“Such factors promote the spread of microbes, some of which can be resistant,” he explains.

When antibiotics are used, some bacteria will die but resistant ones can survive and even multiply: “As such, the overuse of antibiotics makes resistant bacteria more common.

“The more we use antibiotics, the more chances bacteria have to become resistant to them,” he says.

New plan in the works

To address the growing threat of AMR, the Health Ministry is currently finalising a new national action plan to stop the situation from becoming worse.

It will be a five-year plan, from 2022 to 2026, which is expected to be ready by the end of this year.

“The previous Malaysian Action Plan on AMR, from 2017 to 2021, focused on four areas, education and awareness, surveillance and research, infection prevention and control, and appropriate use of antimicrobials (antimicrobials are agents that kill microorganisms).

“The priority areas covered both human and animal health.

“For the coming second National Action Plan, the environmental and agriculture sectors will also be involved,” the ministry says.

To slow the emergence of AMR and prevent its spread, it says there’s a need to increase public knowledge and understanding of the problem and the use of antimicrobials like antibiotics.

“Findings from a nationwide survey in Malaysia show the awareness of AMR is still not satisfactory, especially among the lower income group,” it says.

The ministry also continuously carries out enforcement on the sale of antibiotics to ensure it is under control.

Currently, antibiotics’ sales and use are controlled under the Poisons Act 1952 and may only be supplied by licensed practitioners, registered veterinarians and licensed pharmacists, with valid prescriptions.

“The online sale of antibiotics is prohibited under the same Act,” the ministry says.

Meanwhile, the use of antibiotics in health facilities is also monitored through surveillance activities conducted annually at government and private hospitals, public health clinics and other facilities.

“The Department of Veterinary Services, Fisheries Department, and National Water Research Institute of Malaysia have also conducted AMR surveillance under their purview.

“The findings from the surveillance are presented and discussed at the National Antimicrobial Resistance Committee Meeting which is held annually,” the ministry says.

Besides that, the Agriculture and Food Industries Ministry has shared responsibility in tackling AMR in food animals through promotion of good farm hygiene.

“This is done by strengthening the audit programme in the Malaysian Good Agricultural Practices and Malaysian Aquaculture Farm Certification Scheme.

“Such efforts encourage farmers to use antimicrobials more responsibly,” it says.

On the usage of antibiotics in food animals, Dr Raj Kumar says many farmers indiscriminately use antibiotics on their livestock and once consumed by humans, we indirectly consume these antimicrobials as well.

“Antibiotics are also easily available all over the country in many outlets.

“Although we have laws in place, there is no proper enforcement of this,” he points out.

Dr Raj Kumar believes Malaysia can reduce AMR by educating the public and healthcare professionals.

“We need to have proper enforcement and audit of treatments by doctors from time to time to keep everyone on point.

“The Agriculture and Food Industries Ministry also should monitor farms and farmers. It is a multi-agency problem,” he says.