North & South – June 2019

NORTH & SOUTH| JUNE 2019| 39

Inhospitals,Chamberssays,we’re

doingprettywell– betterthantheUK

andAustralia,atleast.Ournumberof

“defineddailydoses”ofantimicrobi-

alsis 700 per 1000 occupiedbeddays

(theinternationallyrecognisedmeas-

urement),whileAustraliais 900 and

theUKaround1200.Itmeansthat

onlysmallgainsarelikelytobemade

there.Anotherareatowatchisrest

homesandaged-carecommunities,

saysChambers,whowarnsthelossof

trainednursestobetter-paidjobsin

hospitalscouldimpactinfectioncon-

trolintheseat-riskpopulations.

The other issue over which we have

cansometimestakeweekstogetbetter,

andtheythinktheyneedantibiotics.

Insomesituations,doctorsmayfeel

thepressureifthepatientispushing

forsomething,andfeelobligedtogive

them,buta lotofthetimethingswould

resolveontheirown.I don’tthinkpeo-

plerealisehowdangerousantibiotic

resistancecouldbe.”

Kathynowtakesa supplementthatpre-

ventsbacteriaadheringtothebladder

wallanddrinksplentyofwaterandcran-

berryjuice.“IknowI’mpronetoresistant

infections,soit reallyworriesmeandI

havetoconcentrateonkeepingwell.”

SepsisTrustpatronProfessorSteve

ChambersfromtheUniversityofOta-

go,a recentlyretiredinfectiousdisease

specialist,saysaddressingcommunity

expectationwillbeanimportantpartof

thepushbackagainstantibioticresist-

ance.“Antimicrobialuseshowsa rather

startlingriseoverthewholecountry,

andinmyopinion,that’snotdueto

usagegoingupinhospitals– thevast

majorityisinthecommunity.Finger-

pointingatanyoneisa reallybadidea,

butthereis increasingdemandforhos-

pitalservices,andbecauseofthat,in-

creasingpressureonGPstokeeppeople

outofhospital.Andthereisthepres-

sureofmoney.Indaysgoneby,if some-

onewenttotheGP,thedoctormight

saycomebackandseemeina couple

ofdays[ifyoudon’timprove].Nowthe

patientsays,‘Well,doc,I don’twantto

havetocomebackandseeyou,’sothere

is pressure to prescribe then and there.”

That’snottosayresistanceproblems
aren’ta dailyissuefordoctors.Hesays
whenhestartedtraining,almostevery
germthatcausedbladderinfectionsin
womencouldbeeasilytreatedwithoral
antibiotics.“Butnow,oncea weekor
monthinourhospitals,therearewomen
admittedforintravenousantibioticsto
treatcystitis.It getscured,butit is expen-
siveandinconvenient.Theyneedonly
tobeadmittedfora fewdays,butthat’s
a bigchange.It’sgonefrombeingvery,
veryrarethatit couldn’tbetreatedorally
tohappeninginmaybe5-15%ofcases.”
ChristchurchpharmacistKathy*,33,
whohasbattleda seriesofantibiotic-
resistanturinarytractinfections,now
regardsantibioticsassomethingshe’d
takeonlyin“lifeordeath”situations.
Shedevelopeda severeUTIin 2011
aftershockwavetreatmentforkidney
stonesandwasadmittedtohospital
withsepsis.Althoughsherespondedto
intravenousgentamicinandAugmen-
tin,shebelievesshewascolonisedwith
antibiotic-resistantbacteriaduringher
hospitalstay;whenshesubsequent-
lydevelopeda UTIwithina coupleof
monthsofherdischarge,itdidn’tre-
spondtothreeoralantibioticsandshe
hadtobereadmittedtohospital.
Antibioticsarethemostcommon
drugsshedispenses– andabout10%of
prescriptionsareforwomenwithUTIs.
Shebelievesantibioticsingeneralare
overused.“PeoplecomeinwithwhatI
thinkis anuncomplicatedviral cold that

GETTY

Aucklandinfectiousdiseases
specialist Mark Thomas.

Basicmeasuressuchashand-washingarestillvitaltools for

hospital staff combating the spread of infections.

“ ITFEELSTOME

LIKEIT’SCREEPING

SLOWLYANDTHERE

WILLEVENTUALLYBE

ATIPPINGPOINTAND

THEREARETHINGS

WEUSEDTOBEABLE

TODOSAFELYWE

WON’TBEABLETODO

SAFELYANYMORE.”

AYESHAVERRALL,

ANINFECTIOUSDISEASES

SPECIALISTAT

WELLINGTON HOSPITAL

*Name has been changed