Germs build defenses

The overuse of antibiotics and failure to meet stringent hygiene regulations at hospitals have contributed to the rise of hospital-acquired (nosocomial) infections due to antibiotic-resistant bacteria in Greece. In order to battle these infections, doctors often have to dredge up old-fashioned treatments or resort to new-generation antibiotics and risk limiting future therapeutic options. According to Dr Eleni Giamarelou, pathology professor, infectious disease specialist and director of the Third Pathology Clinic at the Attikon Hospital, there are three especially resilient bacteria in circulation at Greece’s major hospitals: klebsiella, pseudomonads and acinetobacter. These bacteria are responsible to a great degree for the occurrence of serious hospital-acquired infections. These infections usually manifest themselves as hospital-acquired pneumonia (35 percent), septicemia (20-25 percent), infection in and around operated areas (20 percent) and infections of the urinary tract (10-15 percent). «Klebsiella,» says Giamarelou, «is especially resilient to all antibiotics except tigecycline, a new antibiotic that is due to circulate on the Greek market soon and which, in the meantime, hospitals are supplied through the National Pharmaceutical Organization (EOF). Pseudomonads often show resistance to many of the antibiotics that are supposed to combat them so doctors have had to dig up an antibiotic that was used back in the 1950s, colymycin. This particular drug has been used for the past two years at intensive-care units (ICUs) in hospitals around the country in order to combat pseudomonad infections, which however, have built up a resistance against it on a scale of 4.5 percent, due to its frequent use. Right now, colymycin is used to treat septicemia, while tigecycline is also effective against this bacteria,» explains the doctor. This new antibiotic is a modified form of a tetracycline antibiotic, whose greatest advantage is that it is not susceptible to the defense mechanisms developed by bacteria and which render the older tetracyclines ineffective. This means that the bacteria effectively builds a wall that keeps the drug out of its core. For older forms of tetracycline, bacteria would produce enzymes that would neutralize the drug’s antibiotic properties. Giamarelou notes that «even this new antibiotic cannot be counted on as a sure solution, because, if it is not used exactly as it should, ‘smart’ bacteria will certainly find a way of building a resistance to it as well. The future looks very dark, because there is no chance of new antibiotics being developed for at least another 15 years.» «The only thing we can do,» adds Giamarelou, «is to find a way of making the bacteria susceptible to antibiotics once more. Bacteria use up a great deal of energy in order to activate their defense mechanisms, and this exhausts them. Therefore, if we stop suppressing them by taking too many antibiotics, they will deactivate their defense mechanisms and become susceptible to treatment again. Doctors obviously play a very important role in achieving this.» According to official data, Greece ranks first among other European countries in the consumption of antibiotics, both inside and outside hospitals, and is among the first in terms of bacterial resistance to antibiotics as well. Hospitals especially often choose to use new-generation antibiotics where older ones would suffice, and they frequently prescribe treatments for longer than necessary. Other than the overconsumption of antibiotics, another culprit in the spread of hospital-acquired infections is the non-application of stringent hygiene regulations, which results in the spread of bacteria among patients within the hospital environment. According to Giamarelou, «doctors and hospital staff scrubbing up thoroughly is one of the basic principals of hospital hygiene. Proper scrubbing of the hands, however, does not remove the multiresistant bacteria found in the hospital environment. To do this, or to kill the bacteria, you must use an alcohol-based cleanser before and after every contact with a patient. «At the Attikon Hospital, the Committee of Nosocomial Infections has ensured that each bed has a disinfectant cleanser dispenser that allows easy use by doctors and nursing staff whenever they are with a patient. «This has been in use for the past year and already 80 percent of staff apply the method regularly.»

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