more_vertOn Feb 5, 1963, President John F Kennedy made a provocative speech to the US Congress. His topic? Mental illness. According to Kennedy, mental health problems affected more people, required longer treatment, drained more financial resources from both individuals and the state, and caused more suffering than other health conditions in the USA. The situation, he emphasised, could not persist. Claiming that recent public health advances had largely controlled infectious diseases, Kennedy argued that a similar “bold new approach” was required to “attack” mental health problems.
Preference: Infectious Diseases and Parasitology
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Measles alert at Queensland university
Queensland Health has issued a measles alert after an infectious person attended lectures at University of Queensland St Lucia campus last week and on Monday.
The student attended the UQ Faculty of Business on Wednesday 29th July, Friday 31st July and Monday 3rd August however did not realise they were infectious with measles.
They also used public transport and visited other locations around Brisbane while they were infectious.
Locations include:
- South Bank to/from Indooroopilly Shopping Town by bus on Tue 28 July afternoon
- South Bank to UQ/St Lucia by bus No. 66 on Wed 29 July morning
- Bus from UQ/St Lucia to South Bank and The Fox Hotel Wed 29 July afternoon/evening
- Lunchtime at Advanced Engineering Café UQ/St Lucia Wed 29 July
- South Bank to/from UQ/St Lucia by bus No. 66 on Fri 31 July morning / evening return
- Pharmacy at UQ/St Lucia Fri 31 July morning
- South Bank to/from UQ/St Lucia by bus No. 66 on Mon 3 August morning / afternoon return
- South Bank to UQ/St Lucia by bus No. 66 on Tue 4 August morning
- UQ Health /St Lucia Tue 4 August morning
Queensland Health has put out an alert telling students, travellers and others who were in the premises to be alert for measles symptoms.
Metro South Health public health physician Dr Kari Jarvinen also reminds those who think they may have measles to call their medical practice rather than just dropping in.
“It is very important to call the medical practice first to say you could have measles, so that staff can take precautions to avoid spreading the disease to others.”
This is the second measles alert in Brisbane in the last two weeks.
Foreign aid cuts a health disaster for many
As a final-year medical student, I am the first person to admit that I’ve been very fortunate so far in life.
Most of these blessings are facets of our rich, first-world society – free, high-quality health care and cheap tertiary education, not to mention the basics that I take for granted every day like somewhere to live, food and clean water.
Sometimes, though, it can become easy to forget two things. Firstly, I did nothing to deserve these blessings. Secondly, billions of people around the world are less privileged than I am. For these reasons, I am thoroughly disappointed in the $1 billion cuts to foreign aid announced in the recent Federal Budget.
Under the previous Labor government, Australia had a bipartisan commitment to contribute 0.5 per cent of its Gross National Income (GNI) to foreign aid, though this was delayed several times.
Little did we know at the time that the 0.38 per cent of GNI level reached at the time Labor left office would be the peak.
Since then, a succession of major Budget cuts by the Coalition Government have driven to our foreign aid contribution down to the point where we are now only giving 0.22 per cent of our GNI.
These cuts fly in the face of the 0.7 per cent of GNI commitment Australia agreed to at the UN in 1970, and which has been repeatedly reaffirmed ever since.
Meanwhile, our counterparts in the UK have recently passed a Bill legally ensuring that they will continue to give at least 0.7 per cent of GNI as aid.
Doctors and medical students alike should be unequivocally outraged.
Our profession is one in which we are privileged to have the opportunity to help people each and every day.
In medical school, we are taught that it is essential to be an advocate for our patients, especially those who have no voice. We must apply this principle to the people of the developing world and fight for effective altruism.
The recipients of Australia’s development assistance have no real means by which to communicate their needs with our government, but doctors can take up this mantle. Of course, various advocacy groups are already doing this. However, it is clear that current efforts are inadequate.
We need to face the facts – these aid cuts will equate to lives lost. Real people with families will die. Australia’s foreign aid provides vital health services in developing countries, as well as emergency assistance to other countries when disasters strike, such as the recent earthquakes in Nepal.
If Australia, one of the most economically developed countries in the world, refuses to provide these funds to countries in our region, who will?
We tend to forget it, but giving aid also benefits us.
Along with the obvious advantages of diplomatic relations associated with generous aid, Australia should leverage its expertise as a leader in tropical diseases to fight the epidemic of tuberculosis in Papua New Guinea, or else the consequences might spread to our shores. Instead of diverting our aid money to offshore detention programmes for refugees, we should invest in developing countries to alleviate poverty and assist displaced people whose lives have been torn apart.
It is the responsibility of doctors to advocate for not only the health outcomes of Australian citizens, but those individuals without the good fortune to be born within our sunny borders. Foreign aid is an essential component of Australia’s contribution to global health and wellbeing, and must be consolidated rather than compromised.
Nicky Betts is a final year medical student at the University of Western Sydney, and Vice-Chair External of AMSA Global Health.[1] [2] [3] [4] [5]
Splenic abscess complicating gastroenteritis due to Salmonella Virchow in an immunocompetent host
Clinical record
A 20-year-old man was admitted to a regional hospital with fevers, rigors, anorexia and left upper quadrant pain. It was his fourth presentation to the emergency department in the preceding 10 days. On the first two presentations, he had been sent home with a provisional diagnosis of renal colic. After review by his general practitioner, he had undergone outpatient imaging that identified filling defects in the pulmonary arteries of his left lower lobe, which were reported as being consistent with pulmonary emboli. In addition, two hypodense splenic lesions were identified, as well as collapse and possible consolidation of the left lower lobe. His GP had referred him to the emergency department for further review (his third presentation), after which he had commenced therapeutic anticoagulation for a presumed diagnosis of pulmonary emboli.
The patient’s history was notable for a self-limiting episode of gastroenteritis 6 weeks before his initial presentation, with sick family contacts. On his fourth presentation, he described progressive left upper quadrant and flank pain over the preceding 10 days, with intermittent fevers and rigors. He had no other focal infective symptoms on review.
On examination, he was found to have a fever (temperature, 39.3°C), sinus tachycardia (heart rate, 154 beats/min), tachypnoea (respiratory rate, 28 breaths/min), hypotension (blood pressure, 97/66 mmHg), decreased breath sounds at the left base of his lung fields and mild left upper quadrant tenderness. Investigations showed a white cell count of 16 × 109/L (reference interval [RI], 4.0–11.0 × 109/L), with a predominant neutrophilia (neutrophils, 14 × 109/L [RI, 2.0–7.0 × 109/L]). Results of his liver function tests and electrolyte, urea and creatinine levels were all within reference intervals.
A computed tomography scan of the chest and upper abdomen again showed two low-density lesions of unclear aetiology in the spleen, as well as a left-sided pleural effusion and collapse of the left lower lobe. Given the possibility that the hypodense splenic lesions represented septic emboli from a cardiac source, the patient was treated empirically with benzylpenicillin, flucloxacillin and gentamicin for a provisional diagnosis of endocarditis. However, a transthoracic echocardiogram performed the next day did not support this diagnosis, with no abnormalities detected. Beyond the radiological findings described, there were no other clinical grounds to support a diagnosis of endocarditis.
Blood cultures taken on Day 1 of admission were positive for gram-negative bacilli, with confirmation of a non-typhoidal Salmonella species (later confirmed as Salmonella Virchow) the following day. This allowed targeted antibiotic therapy, once susceptibilities were known, with ampicillin (2 g every 6 hours). Cultures of stool samples taken at admission were positive for the same isolate, consistent with the patient’s self-limiting episode of gastroenteritis 6 weeks before his first presentation.
Magnetic resonance imaging of the abdomen suggested that the two splenic lesions were likely to represent abscesses in this clinical context (Figure). Given our patient’s ongoing sepsis, a decision was made to perform a laparoscopic splenectomy for source control on Day 5 of admission. Surgical specimens tested positive for Salmonella Virchow. Histopathological testing identified cystic lymphangiomas of the spleen. Despite problems with postoperative pain and a prolonged ileus, the patient made a full recovery. He received appropriate post-splenectomy vaccinations, along with a total of 2 weeks’ intravenous ampicillin, followed by a 2-week course of oral amoxicillin.
Non-typhoidal salmonellae are common foodborne pathogens. In Australia, they are the second most frequent bacterial isolates identified in cases of acute gastroenteritis, after Campylobacter jejuni. In 2010, OzFoodNet sites reported 11 992 cases of Salmonella infection, a rate of 53.7 cases per 100 000.1 Salmonella Virchow was the third most common isolate, after Salmonella Typhimurium and Salmonella Enteritidis. Non-typhoidal Salmonella infection outbreaks are most commonly associated with consumption of poultry and eggs, but have also been linked to fresh produce and, increasingly, contact with pet reptiles.2
Up to 8% of patients with gastroenteritis secondary to non-typhoidal Salmonella infection develop bacteraemia.3 Risk factors for invasive infection include extremes of age, immunosuppressed states, malignancy, HIV infection and use of tumour necrosis factor-blocking medication.4 Our case is unusual in that bacteraemia occurred in an otherwise immunocompetent host.
Extraintestinal focal infections have been reported to occur in 5% to 10% of patients with non-typhoidal Salmonella bacteraemia.3 The best recognised complications are endovascular infections, most commonly involving the aorta, that result from seeding of atherosclerotic plaques and aneurysms.5 However, focal infections of almost all organ systems have been reported.
Splenic abscesses are most commonly seen as a complication of infective endocarditis, occurring in about 5% of patients.6,7 They are also found as a rare complication of non-typhoidal Salmonella infections. In one case series of 49 patients from southern Taiwan, Salmonella species were the third most common pathogens isolated from splenic abscesses, accounting for 11% of cases.8 The most common presentations among the 49 patients with splenic abscesses were fever (47 patients), abdominal pain confined to the left upper quadrant (33 patients), left pleural effusion and splenomegaly (both 27 patients), all of which were present in our patient.
About 50% of patients presenting with splenic abscesses have pre-existing anatomical abnormalities.9 The cystic lymphangiomas identified in our patient almost certainly predisposed him to developing splenic abscesses.
According to the literature, the mainstay of treatment for splenic abscesses is splenectomy. Data from 287 cases published between 1987 and 1995 suggested that non-operative management, which included invasive treatment with percutaneous aspiration and catheter drainage, had a success rate of less than 65%.10 The same series suggested that antimicrobial therapy alone had a success rate of less than 50%. Salvage splenectomy, however, was not shown to result in increased mortality. Another retrospective study of 51 patients in a tertiary hospital between 1998 and 2003 reported survival rates of 48% with antimicrobial therapy alone, 45% with pigtail catheter insertion and drainage in addition to antimicrobial therapy, and 100% with splenectomy and antimicrobial therapy.11 These results may be influenced by selection bias but do suggest improved outcomes with splenectomy over less invasive strategies.
Lessons from practice
- Splenic abscesses are a rare but potentially life-threatening complication of non-typhoidal Salmonella bacteraemia.
- Splenic abscesses should be considered as a possible source of infection in patients presenting with unexplained fevers and left upper quadrant or left flank pain.
- Splenectomy plus appropriate antimicrobial therapy remains the mainstay of treatment for splenic abscesses.
- Interventional radiological techniques should be considered as a spleen-preserving strategy on a case-by-case basis and where experienced radiologists are available.
Splenic abscesses are a rare but serious complication of non-typhoidal Salmonella bacteraemia that may occur in otherwise immunocompetent individuals. Splenic abscesses should be suspected in patients with unexplained fevers and left upper quadrant pain. The mainstay of treatment is splenectomy with appropriate antimicrobial therapy.
[Correspondence] Management of disease outbreak in Nepal
After reading Buddha Basnyat and colleagues’ letter (June 27, p 2572)1 on Nepali earthquakes and the risk of an epidemic of hepatitis E, I would like to offer constructive criticism on the management of disease outbreaks in Nepal. During the rainy season in Nepal, the quality of drinking water falls below the bacteriological standard because of contamination with faecal matter2,3 leading to outbreaks in infectious diseases. Cholera is endemic in Nepal, with annual outbreaks during the rainy season.
Measles alert in Brisbane
Queensland Health has issued a measles alert in Brisbane after a student from Taringa was diagnosed with the disease.
The man was infected with the disease while travelling and returned to Australia last Wednesday.
Public Health Physician Dr James Smith said: “Although this person didn’t get measles in Australia, he would still have been very infectious when he was out in the community between Wednesday and Saturday last week.”
The man was in the following locations while infectious:
- Brisbane Airport – Domestic Terminal on Wednesday 15 July. He was a passenger on Qantas flight QF524 from Sydney.
- University of Queensland, St Lucia between Thursday 16 July and Saturday 18 July
- Indooroopilly Shopping Centre on either 16 or 17 July
Queensland Health is urging anyone who develops these symptoms to isolate themselves from school, work and social activities and to seek medical advice.
“It’s very important to call the medical practice first to say you could have measles, so that staff can take precautions to avoid spreading the disease to others,” Dr Smith said.
Anyone born during or since 1966, who has not had two documented doses of measles, mumps, rubella (MMR) vaccine or had proven measles, should visit their family doctor to get vaccinated for measles. The vaccine is free for anyone who requires it.
Visit Queensland Health for more information.
Signs not good for flu season
The nation’s top medical officer has issued an urgent call for people, particularly vulnerable groups including pregnant women, the elderly and those with chronic illnesses, to get vaccinated against the flu amid signs the nation is headed for its worst season on record.
Official figures show that so far this year more than 14,124 have caught the flu – double the long-term average for the period – and a third higher than for the same time last year.
In a worrying sign that the flu season is gathering momentum, figures compiled through the National Notifiable Diseases Surveillance System show that in in just one month, from 5 June to 6 July, an extra 4911 laboratory-confirmed cases were reported, including almost 2000 in the first week of July.
Underlining the seriousness of the illness, the Health Department said it had so far been notified of 36 deaths associated with influenza since the beginning of the year, with the likelihood that number will rise sharply as the rate of infection accelerates.
Commonwealth Chief Medical Officer Professor Chris Baggoley specifically urged people considered to be at risk, including those aged 65 years and older, Indigenous Australians, pregnant women, and those with cardiac disease and chronic respiratory conditions and illnesses, to take advantage of the free vaccine provided by the Government.
“Flu is highly contagious and spreads easily from person to person, through the air, and on the hands,” Professor Baggoley said. “We need to get higher uptake [of the vaccine] among these groups.”
The Chief Medical Officer emphasised the importance of doctors and other health professionals in helping ensure people were vaccinated against the disease.
“Immunisation is still the best form of protection from influenza, and health care professionals play an essential role in ensuring high uptake,” he said.
The National Seasonal Influenza Immunisation Program began late this year because of a rare double strain change in the vaccine to cover two new strains of the virus – one of which caused havoc in the northern hemisphere.
In the US alone, around 100 children were reported to have died from the flu during the northern flu season, and there was also widespread illness among the elderly.
For the first time under the national immunisation program, Australians have access to single-dose vaccines covering the four most common flu viruses, including three quadrivalent formulations.
The World Health Organisation and the Australian Influenza Vaccine Committee have recommended that vaccines this year cover one existing and two new strains – the California H1N1-like virus that has been in circulation since 2010, the Switzerland H3N2-like virus and the Phuket 2013-like virus.
There have been claims that the delay to the vaccination program has contributed to the strong start to the flu season by leaving a large number of people unprotected, and Professor Robert Booy of the Influenza Specialist Group told the Herald Sun fewer people had been vaccinated that “we would have liked”.
But Health Minister Sussan Ley said the Government was ahead of where it was last year in acquiring vaccine doses.
Ms Ley said that so far in 2015 4.5 million doses had been bought under the National Immunisation Program, 200,000 more than were distributed in 2014.
She did not say how many of these doses had been administered.
Ms Ley said the flu season usually peaked in August and September which, given that it usually takes around three weeks following vaccination to develop immunity, meant people needed to get themselves vaccinated as soon as possible.
Promisingly, early figures suggest vaccinations are helping to reduce the number and severity of infections.
The pilot Flu Tracking surveillance system, a joint University of Newcastle, Hunter New England Area Health Service and Hunter Medical Research initiative that collects data from a weekly online survey, has so far identified only low levels of influenza infection.
But it found that 3.4 per cent of those not vaccinated against the flu suffered fevers and coughs, and 2.1 per cent had to take time off work, while among those vaccinated, 2.7 per cent had coughs and fevers and 1.6 per cent reported having to take sick leave.
The results underline calls from AMA Vice President Dr Stephen Parnis for people, particularly elderly and vulnerable patients and health professionals, to make sure they are vaccinated against the flu.
Dr Parnis said it was important for doctors, nurses and other health workers to get the flu vaccine, for the sake of their own health as well as that of their patients.
Adrian Rollins
Practices dumping bulk billing as Medicare rebate freeze bites
Pensioners and the chronically ill are being charged up to $30 to see their GP as cash-strapped medical practices squeezed by the Federal Government’s Medicare rebate freeze are being forced to abandon bulk billing and begin charging even their most disadvantaged patients.
In a development that bears out warnings from AMA President Professor Brian Owler that the four-year rebate freeze for GP services amounted to the introduction of a GP co-payment “by stealth”, numerous doctors and practice managers have contacted the AMA to report how they had been forced to increase patient charges – and in at least one case, shut down – because of a growing shortfall in the Government’s contribution to the cost of care.
Among them is Tasmanian GP Emil Djakic, whose practice – in Ulverstone and Penguin – has just introduced a $30 charge for the hundreds of patients who had previously been bulk billed.
Dr Djakic said it was a difficult decision given the tough financial circumstances of many of his patients, but the practice’s own financial position made it unavoidable.
He said that absorbing the full impact of the Medicare rebate freeze would have cost the practice $60,000 a year – $240,000 if it remains in place for four years – which would have undermined its viability.
“In our practice, we have charged those who are better off to help provide services at a discount for those less well off,” Dr Djakic said. “But we have now reached an inflexion point, triggered by the rebate freeze, where it is increasingly unaffordable.”
Related:Medibank-Calvary contracts stand-off: what it means for doctors and patients
The practice, which has a 10 full-time equivalent GP workforce, has been bulk billing about 75 per cent of patients. Under changes that came into effect from 1 July, every patient will be charged a $30 fee for the first consultation of the financial year. Any subsequent charges are at the discretion of the individual practitioner, though Dr Djakic said staff were asked to be mindful of the growing gap between the value of the rebate and practice costs in deciding whether or not to ask for a contribution.
Dr Djakic said the practice was bracing for an increase in defaulted payments, but added that so far patients had been surprisingly receptive to the change.
He said the lack of widespread outrage showed the Federal Government had been “incredibly deft” in introducing this latest version of a GP co-payment.
“Just from the viewpoint of a political exercise in shifting costs onto the patient from the Government, it has been very elegant,” Dr Djakic said.
While some practices are increasing patient charges, others are succumbing to the accumulated financial strain caused by the ever-diminishing value of the Medicare rebate.
In Redfern, doctors operating a small practice that has served the community for 34 years have made the painful decision to shut down.
Dr Marie Healy, who for the past 11 years has worked at the practice owned and operated by Dr Adrian Jones, said rising running costs, inadequate Medicare rebates and the inability of a high proportion of patients to pay a gap fee had over time made the practice’s financial position increasingly perilous.
“Yes, Redfern house prices are very high, but there is still a lot of disadvantage here,” Dr Healy said. “We have a lot of patients who are concessional, are elderly, who have chronic diseases, who have diabetes and who are on multiple meds.”
Dr Healy said she bulk billed around two-thirds of her patients because they could not otherwise afford the care they need, and the Federal Government’s original plan to impose a $7 patient co-payment had sent many “into a tizz and caused a high level of anxiety”.
She said two years ago the practice introduced a gap fee for non-concession patients, concession patients seeking a second opinion, and patients who needed a mental health plan, and it increased the charge on 1 July.
Last year, to further trim costs, it dropped out of the practice accreditation system because it was “too costly”.
But Dr Healy said that, with such a high proportion of patients on concession cards who were simply unable to pay, the extra revenue from gaps fees proved to be insufficient to keep the doors open.
The accumulated financial pressure from years of increasingly inadequate Medicare rebates meant that when the rebate freeze came into effect, it was the proverbial straw that broke the camel’s back, she said.
“Adrian Jones is a very conscientious and ethical doctor who is always doing stuff free for patients – visiting an elderly patient at home because they can’t come in, filling out forms for them – but it all hits the bottom line, and we just can’t keep doing it.”
Other practices have indicated they can no longer afford to bulk bill patients and have, or soon will, begin charging patients – including full pensioners – a fee.
Related: AMA: How to pay for Health
In addition to abandoning bulk billing, many are also looking to cut costs and make savings, including by trimming work hours, deferring equipment and facility upgrades and purchases, and reducing services.
The Government expects the Medicare rebate freeze will save it $1.3 billion by mid-2018, but Professor Owler said that cost was simply being dumped onto patients and doctors.
“This funding shortfall has to be met by patients and practices,” he said. “While the rebates have remained unchanged, the costs of providing quality medical services, such as wages for practice staff, rent, electricity, technology, and insurance are increasing every year. Medical practices cannot absorb these increasing costs for four years in a row and remain viable.”
Dr Healy said she felt the rebate freeze was part of a general assault by the Federal Government on primary health care that was particularly difficult to stomach when it had recently concluded an $18.9 billion, five-year deal with the pharmacy sector.
The AMA President warned the freeze would also have a significant effect on private health insurance, including forcing up premiums.
“Some private health insurers have indexed their schedules of medical benefits, which means they are covering the Government’s shortfall, but others will not index their medical benefits until the Government lifts the freeze,” he said. “This will put upward pressure on the costs of medical services and private health insurance premiums.”
We need more than just new antibiotics to fight superbugs
By 2050, drug resistant diseases could be killing more people than cancer, an extra 10m deaths per year. They could also cause a loss to the global output of US$100 trillion dollars – equivalent to a sum greater than the size of the current global economy.
A potential future catastrophe in healthcare, where even routine surgical procedures and easily treated infections become significantly more hazardous, is commonly attributed to the appearance of new strains of antibiotic-resistant bacteria. It is often argued that the answer is more funding for the development of new antibiotics.
What is less commonly recognised is the possibility of a future catastrophe in food production. Modern practice means the extensive use of antibiotics in the farming of fish, poultry and meat. In the US, 70% of all antibiotics enter the food chain.
An arms race against natural selection
Antibiotics are effective against bacteria, just one class of microbe, while the term antimicrobial resistance (AMR) covers the development of resistance in a wider group of bacteria, fungi, viruses and protozoa (such as malaria) to the various measures used to combat them.
The development of new antimicrobial drugs is an arms race against natural selection that cannot be won: when antimicrobials (not just antibiotics) are applied, microbes of all types (not just bacteria) have proven to be adept at developing resistant strains from the survivors. If the drug kills 99.99% of a population of microbes, it is the genetic makeup of the survivors that goes forward to the next generation. To mitigate against potential catastrophes in healthcare and food production, measures over and above the development of new antibiotics have to be undertaken.
These include two key elements. One is infection prevention. If a dangerous microbe never enters the body, no antimicrobial is required. The development of new microbe-resistant materials and products, as well as the development of minimally invasive procedures in hospitals and clinics, improvements in waste disposal and a revolution in cleaning, are some of the measures already being researched.
However, this does not just involve scientists and clinicians. To take just one example, despite all efforts, many in the UK and the US persist in washing their hands lamentably short of the 20 seconds in warm soapy water that experts recommend. We need better leadership to rectify this by implementing advice from those who understand behaviours in workplaces and homes, and we need to invest in science and engineering that makes proper handwashing easy for the public to adopt.
The second element to reducing the use of antimicrobials is the removal of environments that encourage resistant strains to develop, for example in the body of the patient or farm animal, with simple measures such as ensuring a full prescription is taken rather than stopping early when symptoms disappear – a practice that encourages the survival of resistant microbes. Other measures include the invention of sensors to detect infection early and identify the specific microbe present, so that targeted antimicrobials can be used in place of broad-spectrum agents, one example of responsible antimicrobial stewardship.
We must understand how society, climate, land and water resources interact to alter the risk of microbes moving from one host to another. It is a realistic scenario that a resistant strain in a UK hospital might have emerged because of livestock practices half way across the world, where increased flooding, cultural practices, conflict, the movement of money and populations, and the accepted patterns of behaviour, create an environment very different to our own. Conversely, we could find that resistant strains in far-off countries might have their roots in the use of antibiotics in intensive farming in the UK.
The way to do it
The figure below illustrates how the problem extends geographically, and across the workforce and society. The patient in the hospital bed has a reduced risk of infection if the surgeons use a minimally invasive procedure illuminated with lights that deter microbes, and if the surgical instruments, the trays, the rooms, and the tubes that enter the patient (the catheters, nasal drips, endoscopes and so on) are made of materials on which microbes do not readily adhere, and are properly and promptly cleaned (weekend closure of sterile services departments might appear to save costs in the short term but must avoid allowing Friday’s contamination to dry on before washing on Monday).
The anti-resistance movement. University of Southampton., Author provided
For the patient shown in the figure, wounds can be cleaned and dressed with materials that deter microbes. If infection does occur, it can be promptly targeted with a specific (as opposed to broadspectrum) antimicrobial if it is detected early and rapidly identified (with instruments that feed into a communications hub that alerts the doctor’s phone, which is already becoming equipped with apps containing guidance informed by local susceptibility data).
Treatment of the waste from this patient (solid, fluids and materials contaminated with them) alters the possibility of AMR spreading. Achieving the right hospital environment requires far more than the development of new drugs, and their use by healthcare workers. It goes into the management and maintenance of the hospital, and in to the practices of the people who implement these. New technologies and practices must be designed to ensure that their use will be adopted, which requires understanding design and understanding people.
Indeed, the world outside of the hospital (in the lower half of the figure above) provides an enormous reservoir in which AMR can develop. Analysis and, if necessary, change of our processes and technologies are required in water and waste treatment, and in the production, transport, packaging and retail practices in the food industry.
In many parts of the world, climate change and flooding, war, corruption, politics, received wisdom, traditions and religious practices, and the supply of fuel and money, play a far greater role in food, water, waste treatment, healthcare and the transport of microbes from one host to another, than do the outputs of the drug companies.
The twin potential catastrophes are global, and so are the causes. The solutions lie with scientists and engineers to develop new technologies and embed new practices in the public and workforce; they lie with farmers, plumbers, office workers, water and sewage workers, medical practitioners, food retailers, innovators in business … indeed most of us. And they lie with those who are responsible for shaping behaviour across the world – not just the pharmaceutical companies.
Tim Leighton is Professor of Ultrasonics and Underwater Acoustics at University of Southampton.
This article was originally published on The Conversation.
Read the original article.
[Comment] Diabetes, obesity, and the metabolic syndrome: a call for papers for EASD and the World Diabetes Congress
Diabetes, obesity, and the metabolic syndrome are starting to overtake communicable diseases as major threats to health worldwide. The prevalence rates of diabetes and obesity are rising sharply, and while some of the causes are clear—for example, adverse changes in physical activity and diet, led in some populations by demographic change—better strategies for prevention and treatment are still needed. Research into treatment, public health and education interventions, and epidemiology is urgently required to address this epidemic.