38 | NORTH & SOUTH| JUNE 2019
demic,butmorea seriesofreminders
thatwecannotrelyonantimicrobial
drugstoworkinthesamewayasthey
haveinthepast.Inmostcases,these
infectionswillbea particularthreat
tothemostvulnerable,suchasthose
withunderlyingillness,onimmune-
suppressivetreatment,andthevery
youngandelderly.”
Althoughtheinfectiousdiseasebur-
denislessthanit was50-100yearsago,
it’sincreasinginsomedisadvantaged
groupswhoarecontractingdiseases
relatedtopovertyandpoorlivingcon-
ditions,suchasrheumaticfever,caused
bystreptococcalbacteria.
MarkThomas,associateprofessor
ofinfectiousdiseasesattheUniversity
ofAuckland,whobeganhisregistrar
training 40 yearsago,saysadvances
suchasHIVdrugs,betterchildhood
immunisation,highervaccineuptake,
cleanerhospitalsanda fewnewanti-
bioticshaveimprovedoutcomesin
recentyears.Growingresistancemay
increasedeathsfrominfectionby“an
infinitesimalamount”,buttheoverall
proportion will still be small.NewZealand– andthepercentageis
rising,upfrom20.5%intheearly1990s
to26.6%between 2004 and2008.
Verrallsaysalthoughresistanceis
a growingproblem,“itdoesn’tfeelas
dramaticasanoutbreak.Itfeelstome
likeit’screepingslowlyandtherewill
eventuallybea tippingpointandthere
arethingsweusedtobeabletodosafely
wewon’tbeabletodosafelyanymore.
Toconsenttosurgery,patientsrelyon
usbeingabletosay,‘Yes,thereisa risk
ofinfection,butit’streatable.’Butif that
isn’tthecase,theneventheroutinebe-
comesmuchmorerisky.”
InApril,UnitedStateshealthauthor-
itieswarnedabouta newthreatfroma
yeast,Candidaauris, that’scausingfatal
woundandbloodstreaminfectionsin
hospitalpatientsthereandin 20 other
countries,anddoesn’trespondtoanti-
fungaltreatment.Althoughnocases
havebeenreportedhere,thisillustrates
whatantimicrobial-resistantinfection
lookslike,saysUniversityofOtago
professorofpublichealth,Professor
MichaelBaker.“Itwillprobablynotbe
a single catastrophic event like a pan-GETTYApetridishcontainingthedrug-resistantyeastCandidaauris. UnitedStateshealthauthoritieswarnedinAprilaboutthe
new threat from the fungus, which causes invasive and often fatal wound and bloodstream infections in hospital patients.
Oneofthereport’sco-authors,
AyeshaVerrall,nowaninfectiousdis-
easesspecialistatWellingtonHospital
anda seniorlecturerattheUniversity
ofOtago,Wellington,saystheresults
surprisedher.“Butyoucan’ttellinthe
kindofanalysiswedidwhetherit isa
problemwithover-prescriptionorhigh
need,ora combinationofboth.You
couldsaymoreprescriptionsaregoing
toMāoriorPasifika,soit’shigherneed,
butit mightalsobepeopleover-calling
illnessinthosegroups.Butweknow
wehavea problem,becausetheoverall
consumptionrateis whatdrivesantibi-
oticresistance.”
InMay,theHealthQuality&Safety
Commissionreleaseddatashowing49%
ofpeoplewhovisitedtheirGPin 2017
receivedatleastoneantibiotic.Antibi-
oticusewashighestinthoseagedfour
andunder,orolderthan 85 andliving
inagedcare.Thecommissionsaysthe
datasuggestsantibioticsarebeingpre-
scribedforcoldsandflu,“showingan
opportunitytoreduceuse”.
Infectiousdiseasesarethelargest
contributor to hospital admissions in