Hospitals fear a new, deadly fungus – How big is the threat and what can we do?
Drug-resistant infections are increasing globally. One new member of the superbug family has already caused severe illness in hospitalized patients. Here is what you need to know.
Have you ever taken antibiotics, and do you recall for which illness it was prescribed?
At first glance, this might not seem important, but over-prescription of antibiotics pose a risk of developing drug-resistant infections. In the U.S. alone, approximately two million people get an antibiotic-resistant infection each year, of which at least 23,000 people die.
The problem is also big in Denmark. A recently published study has shown that five percent of all patients arriving in Danish Emergency Departments bring multi-resistant bacteria with them.
As a medical doctor and researcher within infections, I can recognise this picture, and I will share my experiences later in this article. But first, let me turn to a developing danger: Multi-resistant fungi
Fungi infections are on the rise globally
To date, there has been a great focus on drug-resistant bacteria and WHO has even published a list of bacteria for which new antibiotics are urgently needed.
However, focus is now turning towards the threat of the drug-resistant fungi as an increasing number of these infections now appear around the world.
What is drug-resistant infections?
Drug-resistant infections or antimicrobial resistance is the general terminology of when infections become resistant to our drugs.
It happens when microorganisms (bacteria, fungi, viruses, and parasites) change defence mechanism after they are exposed to antimicrobial drugs (antibiotics, antifungals, antivirals).
Microorganisms that develop antimicrobial resistance are sometimes referred to as 'superbugs'.
Just like the bacteria, the fungi are now evolving effective defences to defeat the modern antibiotics.
Candida auris - a new unwanted 'friend'
One such fungus is Candida auris which was discovered in the ear (auris is Latin for ear) of a woman in Japan in 2009.
At first glance it seemed like an easily treatable infection, but it has rapidly spread across the globe and caused severe outbreaks in hospitals of the United States, Venezuela, South Africa, Pakistan, and India.
In Europe, the Candida auris has been identified in Spain, the United Kingdom, Germany and Norway. To date, no cases of Candida auris has been reported in Denmark.
The problem is that the fungus is so invasive that once it is detected in a hospital room it will most likely have spread to the walls, ceilings, curtains, beds etc., and you need specific cleaning equipment to have it removed.
Sometimes even parts of the walls and ceilings needs to be removed to have all fungi eradicated.
Trouble in London
Not that long ago, an outbreak involved 72 patients in an intensive care unit in London. The department had to be shut down for 11 days to be cleaned, and critically ill patients had to be moved to another floor.
Candidate auris is especially dangerous to newborns with immature immune system and the elderly with diseases and a compromised immune system.
According to the Centers for Disease Control and Prevention (C.D.C), nearly half of patients contracting Candida auris die within 90 days.
Antibiotics is not always the answer
When I worked as a general practitioner, I have several times been met by a belief from patients that antibiotics would ‘remove’ their cough or ear pain even though my examinations showed no signs of bacterial infection.
I have even seen medical colleagues prescribing antibiotics to avoid spending time and energy explaining patients why antibiotics might not be an effective treatment strategy in specific cases.
But what does science say?
Firstly, most ear infections are viral (infection with a virus) which means that antibiotics have no effect at all.
Secondly, the viral infections will spontaneously get defeated within few days to weeks without any antibiotics.
Studies have also shown that pain is not reduced either when treated with antibiotics for ear pain. If such patients get antibiotics despite this, they risk side effects such as diarrhoea, vomiting and rashes without gaining any benefit from the drug.
How do we decrease the risk and spread of the multi-resistant infections?
So why am I telling you this?
Widespread and unnecessary use of antibiotics increases the risk of antibiotic resistance. In fact, a recent report has estimated that by 2050 more people will die from drug-resistant infections than from cancer and road traffic accidents combined.
Luckily, there are things we can do to prevent this trend. Here are six of them:
- The volume of intercontinental travel today makes it easier for drug-resistant infections to be spread globally. It is therefore important to take hand hygiene seriously when we are out and about.
- Hospital staff, patients and visitors should remember to wash hands with water and soap and use alcohol-based hand gel regularly and according to guidelines when you are in the hospital. This will prevent that infections are spread from hands on to patients.
- Only use antibiotics when prescribed by a certified health professional, and never demand antibiotics if your health worker says you don’t need them.
- Always follow your health worker’s advice when using antibiotics, and never share or use leftover antibiotics.
- We need to reduce the use of anti-fungal agents and antibiotics in agriculture. Of all antibiotics sold in the United States, approximately 80 percent are sold for use in animal agriculture. This pattern needs to change. Denmark is the world’s largest exporter of pork and has restricted its use of antibiotics, which has decreased the spread of antibiotic resistance in Danish livestock and retail meat.
- Advances in genetics and computer science will likely change the speed in which infections and resistance are detected and reported worldwide. In this way, we can fight back faster when infections evolve to resist drugs.
We can work together to reduce the burden of drug-resistant infections. If you want to know more, watch this nine-minute video, 'Revenge of the Bacteria: Why We’re Losing the War', about how bacteria outsmart our antibiotics.
Marco Bo Hansen works as a research leader at Sani Nudge, a MedTech company with a focus on patient safety and infection reduction in hospitals.
Read this article in Danish at Forskerzonen on Videnskab.dk.