One of the country's biggest DHBs has investigated the rise of "superbugs" that can't be easily treated with antibiotics - and concluded the deadly threat is on our doorstep. Nicholas Jones reports.
Newborns are vulnerable to deadly "superbugs" that could also make life-saving transplant surgeries impossible, a confidential report by a major DHB has warned.
Auckland District Health Board leaders have had a closed door briefing on the threat from bacteria that have become resistant to antibiotics, and been told such bugs are already endemic in some hospitals in the Pacific Islands.
A leading expert told the Weekend Herald the work was a "wake up call" to other DHBs, and action was badly needed: "The threat we face is huge and there is no time to waste".
Travel and patient transfer could hasten the spread here, concluded the Auckland DHB internal report , obtained under the Official Information Act.
Resistant bacteria were emerging and spreading around the world, it warned, "threatening our ability to treat common infectious diseases, resulting in prolonged illness, disability, and death".
Babies, people in intensive care and those with very reduced immune systems will be most vulnerable, and life-saving procedures could eventually become impossible because of the risk of post-op infection.
"Patients colonised with an antibiotic resistant bacteria may be declined for transplantation," the report stated.
People travelling to poorer countries with higher levels of antibiotic resistance, such as within Asia, are at risk of exposure. Gut colonisation may clear over months to years, the report explained, but posed a risk if a person needs medical treatments within that time frame.
Bacteria can also spread within hospitals and to other regions. In the Pacific, antibiotic resistant bacteria was becoming endemic in some hospitals, the report outlined, and "patients transferred from these hospitals to Auckland DHB are likely to be colonised".
The threat is national: there have been non-fatal cases at Middlemore Hospital's burns unit and the neonatal wing of Wellington Hospital.
Nelson-based infectious disease specialist and microbiologist Dr Richard Everts has made 28 trips to the Pacific Islands over 10 years, helping measure and combat antibiotic-resistant bacteria.
Resistance was generally higher there, he said. One example: staphylococcus aureus (which mostly causes skin and wound infection) grown from New Zealand patient samples in 2017 showed about 13 per cent was methicillin-resistant. That proportion was 30 per cent in Kiribati, 49 per cent in Tonga and 52 per cent in Samoa.
Treating such infections required more expensive and dangerous antibiotics, Everts said: "Do these antibiotic-resistant bacteria claim lives? I don't have any data, but I'm sure they do."
There was a number of reasons for more resistance in the Pacific Islands, Everts said, including higher rates of infection and therefore antibiotic use, and more people living in each household, some of which don't have washing machines or good sanitation.
Travel and patient transfers meant the situation was also a problem for New Zealand, he said. However, the flow of bacteria goes both ways - methicillin-resistant staphylococcus aureus, for example, was introduced to Tonga from Australia and New Zealand. And in winter thousands of Kiwis and Australians go on holiday along with flu-like viruses.
Globally, about 700,000 people die each year because of drug-resistant infections. The World Health Organisation estimates that could reach 10 million by 2050, if current trends continue.
Despite the growing threat, the Government's response has been scaled down. Last month the Herald revealed the five-year "antimicrobial resistance action plan" floundered amid a $10 million-a-year shortfall, and that key milestones were missed or pushed out.
University of Auckland microbiologist Dr Siouxsie Wiles, author of Antibiotic Resistance - the end of modern medicine?, said the Auckland DHB report was a positive step and "a wake-up call to all our DHBs".
"The threat we face is huge and there is no time to waste in ensuring we are prepared. Already our DHBs are having to deal with patients with very difficult to treat infections, or who are carrying very resistant organisms that mean they need isolating to protect other patients."
The report would have been even more powerful if it included a financial cost on each of the risks, she said. That would help understand "how much of a financial burden AMR [antimicrobial resistance] is going to become".
Wiles said massive investment was needed to carry out the work outlined in the Government's initial antimicrobial resistance action plan, and she worried DHBs will have to meet costs from within already stretched operating budgets.
"Think of it this way - the DHBs have limited numbers of fire extinguishers and are fighting numerous fires. Because we are only seeing the tip of the AMR 'iceberg', I think it's probably seen as a smouldering pile of ashes that doesn't justify the use of the fire extinguishers just yet. But that risks it turning into a ginormous bonfire."
Resistance can happen naturally, but has been turbo-charged by incorrect and overuse of antibiotics in humans and animals.
Properly used, antibiotics destroy disease-causing bacteria. But if taken for a viral infection like a cold, drugs won't attack viruses causing sickness and instead destroy a wide variety of other bacteria.
Those that survive this onslaught can multiply and spread, and share drug-resistant traits with other bacteria. Poor sanitation and infection control can help the spread. Bacteria resistant to several types of antibiotics are often called "superbugs".
In New Zealand, prescriptions of some antibiotics surge by nearly 40 per cent in winter, indicating incorrect prescribing for colds and flu.
Antibiotic resistance has been a health issue for more than 50 years, but grown to the extent that scientists have warned of an "antibiotic apocalypse" that will mean common infections become untreatable.
The Auckland DHB report noted it has been 30 years since the roll-out of a new class of antibiotic that works against bacteria like E coli. Many years of research and funding is needed to bring a new drug to market.
"Even when they succeed, the payoff is small: an antibiotic doesn't sell as well as a drug that needs to be taken daily. The financial incentive for pharmaceutical companies just isn't there. Most of the newer antimicrobials in development are 'variations on the theme'."
The DHB is focussing on infection control like screening patients and hand hygiene programmes, and promoting "antimicrobial stewardship", including the correct use of drugs.
Auckland DHB hasn't had any deaths attributable to antibiotic resistant bacteria. However, the report made clear the risks of doing nothing: "Without effective antimicrobials for prevention and treatment of infections, medical procedures such as organ transplantation, cancer chemotherapy, diabetes management and major surgery (for example, caesarean sections or hip replacements) become very high risk."