Thursday

23rd May 2019

Feature

Nordic scientists warn Brussels over 'superbugs'

  • The risk of dying from a bacteria infection is growing because bacteria develop resistance to the antibiotics. Bacteria can replicate themselves in 17 minutes (Photo: Carlos de Paz)

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  • Hospitals fight hard to stop antibiotic resistant bacteria from spreading - but is it a losing battle? (Photo: European Parliament)

It is pure science fiction, but not completely without a connection to reality.

In the real world, staff at Nordic hospitals are fighting hard to stop antibiotic resistant bacteria from spreading.

Nykoepings Lasarett, a hospital in Sweden, in March cancelled operations and closed infected sections to stop a superbug named VRE from infecting patients.

As many as 250 patients received a letter from the hospital urging them to test if they carried the bacteria after being treated in the hospital.

"The hospitals do not control the infection yet," reported Sweden's public broadcaster, EKOT, on Thursday (26 April).

The first VRE case was discovered in Huddinge in northern Sweden before the turn of the year and about 60 patients have now been infected in the Stockholm region.

In Nykoeping, 44 patients have been reported infected and the resistant intestinal bacterium has spread further between several hospitals and infected patients also in Umeaa, Oerebro plus Nykoeping for several months.

No patient has been seriously ill until now. Most people do not notice that they have been infected, but patients with weakened health may succumb to serious infections such as blood poisoning.

Global problem

The superbug VRE is part of a much bigger problem, according to Nordic researchers speaking at a seminar in the European Parliament organised by the Nordic council on Wednesday (25 April).

In Europe alone 25,000 people are estimated to die yearly because of multi-resistant bacteria, according to studies published by the Nordic countries.

Less than a century ago, pneumonia often led to death, but the risk was dramatically reduced after the first antibiotic, penicillin, was discovered in 1928.

Antibiotics have been used widely ever since, from human medicine to animal food and saved millions of lives.

But now the risk of dying from a bacterial infection is growing again because bacteria develop resistance to these antibiotics.

"A world without effective antibiotics is the greatest threat to health care worldwide," Aasa Melhus, professor of Clinical Bacteriology at Uppsala University pointed out at the seminar in Brussels.

Antibiotics reduced mortality rates and prolonged life but no new antibiotics have been developed for the past 30 years.

"It is getting dangerous, because we can not offer the citizens anything more," professor Melhus said.

Not a 'traditional business'

The industry has moved focus from infection diseases to old-people's diseases, such as cancer and cardiovascular diseases.

"The industry is not very active in the area, because it is not a traditional business," chief consultant of the Danish Association of the Pharmaceutical Industry, Allan Skaarup Kristensen, explained.

If a new antibiotics was eventually developed it would be very important to restrict the use of it as much as possible to avoid bacteria from developing resistance to it.

"You would make the product, and then put it in a safe box and not use it," he told the seminar in Brussels.

Currently has industry globally only 62 new compounds in the pipeline of which only five are expected to be approved as new antibiotics. It costs around $1bn to develop a new drug and takes up to 10 years.

Skaarup Kristensen said grants and more public funding was needed to discover new antibiotics.

He suggested a $1bn premium for companies to take the risk to bring a new product to the market could be a game-changer - from industry not being active, to becoming active and to quadruple the number of new antibiotics coming to the market in the next 30 years.

Shortage in Europe

Almost all production of antibiotics has been outsourced from Europe to other parts of the world since it is not technically very complicated to produce antibiotics and the old patents have run out.

"We have outsourced almost all production to India and China – but that leaves us with a security problem and sometimes we see a shortage of deliveries," warned Dag Berild, professor at Oslo University Hospital.

"We may consider 'insourcing' of the old-fashion production to Europe," he suggested.

"We all live with two kilo bacteria in our body and they make lots of good use for us. But bacteria can replicate themselves in 17 minutes, so we can never win the war against the bacteria," he said.

"We also need to promote rational use of antibiotics".

The Norwegian government's plan is now to reduce the use of antibiotics by 30 percent by 2020. One way is to shorten the period of treatment.

"We have all learned to finish the treatment with the antibiotics to avoid resistance. But that is a lie. It is total evidence-free area," said the Norwegian professor.

"The longer treatment the more resistant bacteria. So my advice is to change this mantra that 'shorter is better'. Studies of pneumonia and other show that shorter treatment works as well as long treatment," professor Dag Berild said.

Foreign travel risk

It is estimated the 60 percent of all infectious diseases stem from animals - but travelling is also contributing to infection and spread of bacteria.

"The only thing you have to do is to go abroad," said Aase Melhus.

She made a study in 2010 concluding that foreign travel is a major risk factor.

Samples from 100 healthy volunteers traveling outside Northern Europe, taken before and after their travel, showed that 50 percent returned with multi-resistant bacteria.

The most risky country to travel appeared to be India, where 88 percent came back positive.

"After six months 24 percent were still tested positive and as long as you are positive, you can spread it," professor Melhus explained.

"This is a global problem. Whatever happens in the world will in the end end up at your own doorstep," she said.

Nordic 12-step plan

During the Nordic Council's theme session in Stockholm last year, the council's politicians presented a 'white book' outlining 12 concrete proposals for Nordic initiatives in the fight against antibiotic resistance.

The strategy aims to limit the use of antibiotics, stop the spread of antimicrobial resistance and secure incentives for the development of new health technology, innovative medicines, and vaccines.

"It is a challenge that should be met on all levels, regional, national and global. The Nordic Council also wishes to promote ambitions solutions in the EU," said Bente Stein Mathisen, a member of the Norwegian parliament and of the Nordic Council.

So far the European Union has focussed its legislative work mainly on the use of antibiotics for animals.

"From a legislative point of view we worked on animal health – now we see there are also links to human health," said Fredrick Federley, Swedish Alde MEP.

"Many people in this world do not get proper treatment. The poorest do not get what they need, while others are over-consuming antibiotics," he said, adding that "the Nordic action plan could be used as a role model for European Parliament".

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