Implications of antibiotic resistance on sepsis treatment

According to a recent World Health Organisation (WHO) estimate, 49 million cases of sepsis and 11 million sepsis-related deaths were documented in 2017. The largest contributors to the number of incidents and deaths involving sepsis are infections in the digestive tract that usually result in diarrhoea and lung infections. Injuries (mainly from car accidents) and the complications of non-communicable diseases also contribute to a portion of them.

Alarmingly, in the same year, 20 million cases of sepsis in children under the age of five were reported worldwide.

Sepsis is a global threat

Sepsis may not be well known to the general population, despite the statement by the WHO that the condition poses a threat to population health. To put it briefly, sepsis is an unusual response in which cells of the body are attacked by the immune system. Sepsis can arise from microbial infections, including bacteria, viruses, or fungi, as well as from conditions caused by chronic injuries or diseases, such as diabetes.

Subsequently, sepsis can cause organ failure and abrupt low blood pressure, putting the patient at risk of death if not treated immediately. Based on statistical data provided by the WHO, it has been observed that the death rate associated with sepsis among individuals receiving medical care within intensive care units (ICUs) is 42 per cent. Plus, WHO also projected that one out of every four incidences of sepsis can be attributed to a nosocomial infection, i.e., an infection acquired from a healthcare facility.

Sepsis carries a significant risk to human life, and its treatment incurs substantial financial expenses. This is supported by research conducted by the WHO that involved multiple high-income countries. Nevertheless, the comprehensive assessment of treatment expenses in low- and middle-income nations faces challenges due to the scarcity of published studies, despite the higher incidence and fatalities observed in these regions.

The management of sepsis is dependent upon the timely identification of sepsis symptoms and the judicious administration of antibiotics, given that the majority of sepsis cases arise from bacterial infections. However, the issue of antibiotic resistance creates a significant obstacle to the effectiveness of sepsis treatment.

The issue of antibiotic resistance should not be disregarded

Since the first discovery of antibiotics in 1928, these medications have been widely used for the purpose of treating bacterial infections. Antibiotics have been found to reduce the number of deaths from high-risk surgeries as well as deaths among those at increased risk, including children, pregnant women, and the elderly. Furthermore, antibiotics provide more efficient treatments for infectious diseases, including syphilis and tuberculosis.

Yet, inappropriate use of antibiotics is responsible for another prominent health concern, which is the antibiotic resistance. The emergence of antibiotic resistance arises when bacteria undergo changes that confer resilience to currently available antibiotics. As a result, the effectiveness of antibiotics in the treatment of bacterial infections has decreased compared to before. As a result, the use of antibiotics with a broader spectrum of action is required as an alternative.

According to the United Kingdom Health Security Agency's findings, it was observed in 2020 that approximately 20% of patients in the country who were diagnosed with an infection presented antibiotic resistance. The agency has also expressed concerns over antibiotic resistance, which has the potential to manifest as a "latent pandemic" following the Covid-19 crisis if the issue continues to be overlooked by the public.

Antibiotic resistance has escalated in severity due to the discovery of certain bacterial species exhibiting resistance to multiple types of antibiotics. Among these are the metallo-beta lactamase species, which have been discovered to be resistant to all types of antibiotics belonging to the beta lactam class, which also includes the broad-spectrum antibiotic carbapenem. Typically, this antibiotic is used for the treatment of more severe infections and is used only in cases where initial-line antibiotics, such as penicillin and cephalosporin, have proven to be unsuccessful.

The increasing incidence of antibiotic resistance limits the range of medications available for the treatment of patients, particularly those suffering from sepsis. The cost of therapy will likely increase as the prolonged duration of sepsis might require extended hospital stays. Moreover, the treatment of infections associated with prolonged sepsis necessitates the use of typically expensive and less readily available antibiotics.

Factors causing antibiotic resistance

According to the WHO, the use of antibiotics to treat non-bacterial infections is one of the causes of antibiotic resistance. For example, respiratory tract infections, characterised by symptoms like the common cold, coughing, and flu, are typically caused by viruses. It is not appropriate to use antibiotics as a treatment for viral infections.

In addition, the behaviors of some individuals who fail to adhere to the prescribed dosage, frequency, and duration of antibiotic treatment may also contribute to the increased risk of antibiotic resistance. The act of non-adherence to prescribed antibiotic regimens and the practice of sharing medications with others are likely to contribute to a rise in antibiotic resistance.

On top of that, the uncontrolled use of antibiotics for animals and livestock can further contribute to the emergence of antibiotic resistance. In certain developing countries, farmers use antibiotics as a preventive measure against infection, hence promoting the growth of livestock.

Measures to address antibiotic resistance

In order to mitigate the worsening effects of antibiotic resistance, it is imperative to implement a number of different approaches. One of the actions that has been undertaken involves the introduction of antimicrobial stewardship (AMS) initiatives within healthcare facilities, which engage healthcare practitioners across several medical disciplines.

The primary objective of the AMS programme is to promote the judicious use of antibiotics. This encompasses the process of choosing the proper antibiotics according to the diagnosis, prescribing antibiotics at the correct dosage, frequency, and duration, as well as, employing the recommended route of administration.

Additionally, it is important for the public to assume responsibility for preventing antibiotic resistance. The public should take antibiotics according to the dosage and frequency prescribed, as well as complete all medications according to the treatment duration. It is not advisable to discontinue antibiotic medication, even if symptoms improve.

On top of that, maintaining proper hygiene plays a major role in reducing the likelihood of infection. One of the suggested measures includes the use of face masks in crowded spaces, together with regular and proper hand hygiene practices. Also, an effective wound care technique can serve as a prevention against further worsening of wounds and the subsequent susceptibility to bacterial infection. Certain vulnerable populations are recommended to receive specific immunisations, such as the pneumococcal vaccine, in order to enhance the ability of their immune system to combat infections.

Besides, the rational use of antibiotics in animals should also be emphasized. For example, only a qualified veterinarian with a professional assessment of the infections should administer antibiotics for the treatment of infections in pets or livestock. With this step, antibiotics would not be used unnecessarily.

Antibiotic resistance undermines the effectiveness of sepsis treatment

Without proper treatment, sepsis can be fatal, and one of the known effective treatments for sepsis is a rational antibiotic regimen. Even so, the growing threat of antibiotic resistance is likely to make sepsis eventually difficult to control. This, therefore, should be addressed very seriously.

Henceforth, it is crucial that everyone involved collectively and regularly take action to address the issue of antibiotic resistance. Awareness of the rational use of antibiotics not only prevents the failure of treatment for diseases like sepsis and other infections but also helps reduce the cost of health care.

If there are any inquiries regarding medicines, please call the National Pharmacy Call Centre (NPCC) at the toll-free number 1-800-88-6722 during weekdays from 8am to 5pm, except on public holidays.

Mohd Shahiri Abd Ghapar, Pharmacist at Pharmacy Practice and Development Division, Health Ministry.