Filenews 10 December 2022 - by Nikoletta Kouroushi
The top five EU countries with the highest morbidity and mortality, attributed to infections with resistant bacteria, include Cyprus.
Antimicrobial resistance, which is largely caused by the reckless use of antibiotics, is a long-standing systemic problem, which intensified during the pandemic and which, as scientists and technocrats underline, needs interventions at various levels – from the farm, the wider community to hospitals – on the basis of the global strategy "One Health".
In fact, according to recent data from the pan-European antimicrobial resistance surveillance system EARS-Net, most cases of infections with resistant bacteria are recorded in hospitals and especially in Intensive Care Units, while morbidity and mortality, attributed to such infections with resistant bacteria, is of similar magnitude to those of all cases of influenza, tuberculosis and HIV / AIDS.
The topic was discussed extensively in the context of an informative seminar on antimicrobial resistance in Europe, organized by the Cyprus International Institute for Environmental and Public Health of the CUT, on the occasion of the World Awareness Week for the Rational Use of Antibiotics. The keynote speaker was Dr Diamantis Plahouras, senior expert on antimicrobial resistance and healthcare-related infections at the European Centre for Disease Prevention and Control (ECDC) in Stockholm.
As mentioned in the context of the seminar, recent data from the pan-European AMR epidemiological surveillance system EARS-Net show the large increase in reports of Immobilizobacterium in the European Union.
According to the data, most of the increase in infections, due to this resistant microbe to the antibiotic carbapenem, was recorded in the early years of the coronavirus pandemic. Specifically, the total number of infections with Immobilizobacterium, reported in 2020–2021, increased by 57% compared to 2018–2019 before the pandemic, with the number of reports increasing by 114% and the rate of resistance to the antibiotic carbapenem increasing from 48% in 2018–2019 to 66% in 2020–2021.
It is noted that circulatory infections with this microbe occur more frequently in patients of the Intensive Care Unit, while the antimicrobial resistance of Immobilizobacterium and other resistant microbes further complicates the treatment of serious infections in vulnerable groups of patients.
Special reference was also made to the very frequent use of antimicrobial drugs in hospitals and especially in southern European countries, including Cyprus, Greece and Italy.
It is also worth noting that the excessive use of antibiotics takes place beyond the community and hospitals and in animal husbandry. It is recalled that, as mentioned in a previous publication, Cyprus is a "champion" in the use of antimicrobial preparations in animal husbandry, according to the Report of the European Medicines Agency (EMA), with all that this entails for the issue of antimicrobial resistance.
Dr Konstantinos Tsioutis: Immediate preparation of a national strategy is necessary
Asked to comment on the data, Dr. Konstantinos Tsioutis, a specialist pathologist specializing in infection control and prevention, said that "antimicrobial resistance is the result of a chain relationship between the environment – society – hospitals, influenced by individual and collective practices".
He noted that "these practices are briefly classified into prevention measures, infection transmission, antimicrobial administration practices, behaviours and health policies. Simply put, in a place like a hospital, the community, agriculture, animal husbandry, veterinary medicine, if there is an excessive use of antibiotics, these put pressure on the existing microbial population, leading to the survival of resistant microbes, which then spread and eventually prevail," he continued.
"At the same time," he added, "the inadequate implementation of infection prevention measures, whether it be hand hygiene, isolation of patients with resistant microbes, or other specific practices, favours this spread."
He explained that "when, therefore, resistant microbes prevail, they increase the need to use advanced antibiotics, which usually have a higher cost, more side effects or require intravenous administration."
Dr. Tsioutis then stressed that "the cost of antimicrobial resistance in money and health is enormous at a global level, let alone in countries where the problem is already advanced and it immediately becomes apparent how necessary the multidimensional approach with resources, time and specialization is".
In conclusion, he stated that "in Cyprus the magnitude of the problem of antimicrobial resistance and nosocomial infections has already been recorded in our own studies over the last 15 years and the response requires the immediate preparation of a national strategy, based on a holistic approach and on administrative and political support over time".
Yup. Health: Multilevel and cross-sectoral approach
"A long-term, multi-level and cross-sectoral approach is needed, on a systematic basis and in cooperation with all stakeholders, to address the problem of antimicrobial resistance, caused by the reckless use of antibiotics," said Dr. Linos Hadjihannas and Dr. Markella Markou, responsible for the Antimicrobial Resistance and Hospital Infections program of the Ministry of Health.
Asked to comment on the data, they argued that antimicrobial resistance and infections in hospitals are the "tip of the iceberg", the culmination of a problem that is largely created by the overuse of antibiotics in the community, which exacerbates the need to use stronger antibiotics in hospitals. They stressed that therefore, in addition to targeted actions on the part of the authorities, we need to change our culture and understand that we are part of the solution to the problem.
Commenting on the increase in infections with Akilobacteride, during the coronavirus pandemic, they said that due to the pressure of the system (reduction of beds, reduction of the staff-patient ratio, increase in the use of antibiotics) a greater number of hospital infections were recorded. They argued that during the pandemic the antibiotic azithromycin was abused in the community, which was unfoundedly widely administered, despite the fact that antibiotics did not They are used to treat virus infections.
Regarding the actions of the Ministry of Health to address the problem, they noted that "they are part of the broader framework of "Integrated Health", the global strategy, which aims to spread interdisciplinary cooperation and communication in all areas of human, animal and environmental health".
Specifically, the actions of the Ministry of Health, as they mentioned, include, among others, the software for monitoring the consumption of antibiotics in the community and hospitals, the surveillance of infections in hospitals, the implementation of the antibiotic logistics program (use control program, which includes the necessary interventions) and the implementation of the program for the prevention and control of nosocomial infections.
In conclusion, they said that new programs are being designed and are running to strengthen the functioning of infection control committees in hospitals, such as the creation of an electronic platform for hospital infections and antibiotic abuse in the hospital environment, which is expected to be operational in 2025 and will help in better surveillance, through the collection of data in a central system.
