Feature: Microbial resistance is futile

Read part I of Resisting antimicrobial resistance.

At his Australasian Society for Microbiology special lecture given last week, ASM President Professor John Turnidge presented a big-picture view of antibiotic resistance, how it has come about, the situation in Australia and what we can do about it. Although still passionate about the problem, Turnidge is also quite jaded about what is not happening in his own country.

“Australia is, in fact, a really interesting place in the antibiotic resistance field because we have a quite high per capita usage but our resistance rates are lower than those of similar countries.

“This makes it interesting from a scientific viewpoint, but unfortunately it is also a reason for politicians and bureaucrats to pay lip service to the issue and say that we are doing something about it when in reality we are not.”

This is not to suggest it's all bad news from Turnidge's perspective. “I have spent my whole lifetime working on microbial and infectious diseases, thinking about antibiotics and antibiotic resistance, and we have had some wins over the years.”

There have been some regulatory changes, for instance, mainly surrounding new drugs, meaning that resistance is treated like a side effect of the drug and thus dealt with accordingly.

“We have also managed to engage the interest of other organisations with influence in this arena, namely the National Prescribing Service (NPS) and the Pharmaceutical Benefits Scheme (PBS), with some actions taken with respect to warning users of a drug that resistance might be a problem or restricting use of an antibiotic in the community.”

“The veterinary and agricultural industries also now take the issue very seriously with regard to limiting their use of antibiotics in food production,” says Turnidge. Such use worldwide has certainly contributed to the problem and increased the chance of transferring resistant strains down the food chain.

In another win, the influential Australian Commission on Safety and Quality in Healthcare has taken up the issue of hospital-acquired infections and multi-drug resistance in a big way over recent years. “They have put forward various strategies at a national level to try and make a real difference.”

But there's bad news too. “One of the major issues with tackling antibiotic resistance is that no one organisation or group can really own the breadth of the problem and, over the years, that has really impacted our ability to really make a difference. As far as a comprehensive tackling of the issue goes, we have definitely failed.”

Turnidge likens the problem of antibiotic resistance to that of global warming a decade ago, in that a lot of people are talking about it, but some others do not think there is even a problem to address and, as a result, it becomes a political football.

“Yes, there is an issue. And yes, this is the perfect time to act when the resistance rates are low so you can get the most value for your money in effort terms.”

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The way forward

“After nearly 20 years of fretting about this, I don’t really have an easy answer,” says Turnidge. “No one does, and of course that is part of the problem. The issue is still with us and literally getting worse around the world. We all know that we can’t wait forever to fix it.

“It actually requires a lot of ‘small p’ political will – governments (plural) and societies to agree this is an issue and that they want to do something about it, and at the moment there is no real evidence that this is true to any great extent. We need that collective will to make a difference.”

Turnidge hopes that talking in the public arena at ASM at least raises the awareness of the issue and makes people think, or at least talk about it with each other and with their doctor. “It is hard to know if you just have to keep trying to get the message across at a public level, and just keep doing it continually.”

Such an approach has proven successful elsewhere. France had one of the highest rates of resistance in the world a decade ago, and with massive public awareness and education campaigns, they were able to bring it back a little.

Another option is instituting more formal controls – such as limiting access to antibiotics. “We would have to make everyone pull back a bit – users, prescribers and regulators.

“This of course is much harder politically, but maybe that is the only way: to get tough. The difference with antibiotics, of course, compared with something like smoking or pollution, is that there is nothing good about those things where we know that antibiotics are life-saving when used properly. It really is a hard one.”

Of course many researchers worldwide are also trying to find out more about the bacterial mechanisms and genetics used to avoid the effects of antibiotics, so that maybe they can get a step ahead that way.

“We are starting to get a handle on some of the main genes and mechanisms involved over the past 10 years, but it is a slow process”, says Turnidge. “Also, we really need to better understand the whole ecology involved – the organism and the environment.”

One of the problems, according to Turnidge, is that like the bacteria themselves, mechanisms of resistance to antibiotics such as penicillin mould have also been around for millions of years.

“So, whatever we throw at them it is probable that there are bugs out there that know how to get rid of it. We will never stop having resistance, but our job is to keep it at the lowest possible level, and one of the most important ways of achieving that is only to use the drug when absolutely necessary.

“Of course, this is also the hardest thing for society to accept.”

Professor Turnidge completed medicine in Sydney before moving to the Flinders Medical Centre in Adelaide to specialise in infectious diseases and laboratory microbiology. He then did a research year in Wisconsin in the USA, studying the new field of antimicrobial pharmacodynamics, before returning to Flinders Medical Centre and then taking up a position back at the Monash Medical Centre in Melbourne for the next eight years.

Turnidge then returned to Adelaide as head of Microbiology and Infectious Diseases at the Women’s and Children’s Hospital, and then as chief of the Laboratory Medicine division. His research and professional interests are focussed on antimicrobial resistance and its control, and in his own words, Turnidge has spent a lifetime “thinking and fretting” about antibiotic resistance.