Drug-resistant bacteria are becoming a real day-to-day challenge for frontline medics, who said more patients are being admitted to hospital with common infections.
Due to rapid population growth and significant increases in migration, the Arabian Gulf has become particularly vulnerable to anti microbial resistance (AMR), one of the major threats to health care worldwide.
Overuse of antibiotics and inappropriate prescriptions to treat some infections are causing problems for hospitals.
Antimicrobial Stewardship Committee, Burjeel Hospitals
In the UAE, doctors said oral drugs once used to treat common urinary infections or stomach problems are becoming less effective, forcing patients into hospitals to receive more powerful antibiotics via intravenous drip.
That adds further risk of infections, longer patient recovery times and medical expense.
“It is not rare that we come across patients resistant to most antibiotics,” said Dr Niyas Khalid, Burjeel Medical City, a doctor of 17 years.
“A recent 63-year-old with a urinary tract infection was resistant to everything.
“We had to use a higher grade antibiotic, aztreonam, but he was also resistant to that so we had to deliver an antibiotic via an IV drip on a much higher dose.
“It was hard for him to tolerate, but it was the only way to get rid of the infection.
“AMR is real and it is happening now, in most of the hospitals around.”
It is a particular problem in healthcare settings, because resistant bacteria can spread via patient contact, among staff or through contaminated surfaces and medical devices.
Stronger drugs
Higher-grade antibiotics are typically more expensive, and can have worse side effects.
When a patient does not tolerate antibiotics or they are resistant, it leaves doctors with fewer options to treat their condition.
While antimicrobials are essential to modern life, their inappropriate use has allowed the microbial world to adapt.
Bacteria, parasites, viruses and fungi are becoming increasingly resistant to antimicrobial drugs such as antibiotics and antivirals.
According to the UN, AMR was directly and indirectly responsible for an estimated five million deaths in 2019.
By 2050, the number of annual preventable deaths from AMR is expected to double, and rival the numbers of people who died from cancer, which was about 10 million in 2020.
Low and middle-income nations are more at risk, with poverty, poor sanitation and hygiene and pollution increasing infections that could be harder to treat in the years ahead due to AMR.
If a patient has been exposed to lots of antibiotics after frequent infections, they are more likely to be resistant.
Incomplete treatments, or inconsistent use can also transform the bacteria to make it resistant.
Bronchitis is a common complaint this summer, with humid dusty weather conditions increasing the number of people requiring treatment for respiratory problems.
Antibiotics should not always be the first response, said Trilok Chand, consultant and head of the department of respiratory medicine at Burjeel Hospital, Abu Dhabi.
“Antimicrobial resistance is the new challenge for physicians, and the population in general,” Dr Chand said.
“Antibiotics should only be prescribed on strong suspicion of a bacterial infection or there is a sputum culture that has revealed an infection.
“We discourage the use of antibiotics in viral or allergic bronchitis, as it is unnecessarily exposing the patient to antimicrobial resistance.”
National strategy
In the UAE, a strategic AMR national plan was established in 2019 with collaboration between healthcare, food, animal and environment sectors to combat the issue.
Since then, attention in hospitals has shifted towards better infection prevention and control measures, and tighter surveillance of antimicrobial prescriptions.
One of those involved is Jumana Yousef Megdadi, an infectious diseases clinical pharmacist and chairwoman of the Antimicrobial Stewardship Committee at Burjeel.
“We are communicating with physicians to use fewer of these kinds of antibiotics in the hospital because it is causing resistance,” she said.
“They have become resistant to other micro organisms, so we want to decrease their use.
“Sometimes it is not necessary and they are being overused, prescribed to treat a virus.
“It is huge problem worldwide and not just in our hospital.
“We are seeing more and more resistance that will decrease the number of antibiotics that can be used.
“If a broad-spectrum antibiotic becomes resistant, it leaves doctors with few other options.”
When doctors are faced with a drug-resistant infection, a combination of antibiotics are often used.
This in itself brings added risk, because an immunocompromised patient is delivered stronger drugs that can damage liver enzymes, impair renal function or lead to electrolyte imbalance.
In sepsis, the body’s extreme response to infection, failing drugs can lead to organ failure and even death.
Patients in long-term care are more likely to suffer the affects of AMR, because bacteria can become resistant to all antibiotics.
Dr Dima Ibrahim, a transplant infectious diseases specialist in Abu Dhabi, said e-coli was a bacteria often resistant to the usual antibiotics prescribed.
“We usually see abdominal, urinary or skin infections and we use antibiotics guided by the specifics of the bacteria,” she said.
“Patients have a variety of symptoms, and we used to have access to a variety of effective oral antibiotics.
“There are many infections that can be viral or fungal, so we need to be careful how we use antibiotics.
“We are facing resistance issues in hospital, especially those patients admitted for a long time.”
New drugs
Typically, it can take up to 20 years to develop a new antibiotic medication from scratch.
By adding molecules to existing medications, drug compounds can be modified as a temporary measure, but new drugs are needed.
Like many pharmaceutical companies, Pfizer is focusing on research to bring new drugs to market to increase the arsenal of bug-fighting medication.
“We are actively engaged and committed to a multi-faced and evidence-based approach to stewardship, to ensure responsible use of anti-infectives across local healthcare settings,” said Parmjot Bains, Pfizer Gulf Cluster country manager.
“These efforts include health system strengthening, surveillance, infection prevention, including vaccination, policy advocacy, innovative tools, diagnostics, education, research, health equity and patient engagement.
“Governments, industry and the public health community must work together to take action and support measures to enable continued innovation in the development of new antibiotics and to tackle antimicrobial resistance.”
