Antibiotic resistance is serious

More active monitoring is required

Kim Shin-Woo, Chairman of the Korean Society for Antimicrobial Therapy

We need to actively support the introduction and development of new drugs

Antibiotic resistance has been a global issue for several years.

 

In 2016, the British government predicted that 700,000 people worldwide would die from antibiotic-resistant bacteria every year and that the death toll would reach 10 million by 2050 if no special measures were taken.

 

In 2015, the World Health Organization (WHO) presented a 'global action plan' to prevent the occurrence and spread of resistant bacteria transcending borders and urged countries to prepare countermeasures and international cooperation.

 

Carbapenem-type antibiotics, which have the most extensive antibacterial activity, are called the 'last choice', and the number of infections with strains resistant to these antibiotics is rapidly increasing.

 

According to the Korea Centers for Disease Control and Prevention, the number of cases of carbapenem-resistant Enterobacteriaceae (CRE), which was classified as a second-grade infectious disease last year, increased by 31% from the previous year to 30,548.

 

Compared to 2017, when there were 5717, this is a more than five-fold increase in five years.

 

Activities of the Korean Society for Antimicrobial Therapy also focus on antibiotic management to reduce resistance.

 

It is the institutionalization of so-called 'antibiotic stewardship' that uses antibiotics appropriately.

 

As of 2020, antibiotic use in Korea was the 4th highest among 29 OECD countries.

 

As a result of investigating the adequacy of antibiotic prescriptions in 75 domestic hospitals, more than 25% were evaluated as inappropriate.

 

Kim Shin-woo, chairman of the Korean Society for Antimicrobial Therapy

Kim Shin-woo, chairman of the Korean Society for Antimicrobial Therapy (Department of Infectious Diseases, Kyungpook National University Hospital), said in a recent interview with Dailypharm, “Antibiotic resistance has become a situation that cannot be resolved through infection control anymore.” There is a need for systematic institutionalization of education,” he stressed.

 

He then asked for appropriate support to quickly introduce new drugs that have emerged as carbapenem alternatives such as Zerbaxa at an appropriate price and to develop domestically produced new drugs that can be supplied in Korea.

 

- Cases of infection with carbapenem-resistant Enterobacteriaceae are rapidly increasing.

 

How much do you feel on-site? = The level of feeling on the spot is serious.

 

The problems typically pointed out in Gram-negative bacteria resistance are resistance in Pseudomonas aeruginosa, Acinetobacter resistance, and Carbapenem resistance.

 

Among them, Pseudomonas aeruginosa and Acinetobacter mainly cause problems in hospital environments, but carbapenem resistance has a greater ripple effect on the community than these and is more serious because resistance is developed in intestinal bacteria.

 

CRE is a case where doctors do not respond even if they use carbapenem antibiotics, which are called 'last bastions', and colonization can lead to a real infection.

 

If the CRE ratio in a person's bacteria increases, it causes various infections such as sepsis, which cannot be treated even with carbapenem.

 

However, there is no monitoring, tracking, or reporting on this, so there is nothing that can be done even if the number of deaths increases.

 

- Antibiotic resistance is a problem that has been pointed out for a long time.

 

Why was the response delayed? = I think the biggest cause is not knowing the seriousness of antibiotic resistance.

 

About 35,000 patients have died from COVID-19 in Korea, but it is not well-known that many people die every day from antibiotic resistance.

 

There is also a famous prediction that by 2050, we will be in a post-antibiotic era, an era in which antibiotics are ineffective, with more deaths from antibiotic resistance than from cancer.

 

Awareness of the term antibiotic stewardship is also very low.

 

Medical institutions should be moved through continuous publicity and awareness improvement.

 

-The Korean Society of Antimicrobial Therapy is citing institutionalization of the Antimicrobial Stewardship Program (ASP) as its top priority goal in the mid-to-long term.

 

Why is Antibiotic Stewardship Institutionalization Necessary?

 

=Antibiotic stewardship is to reduce the misuse and abuse of antibiotics and lower the rate of resistant bacteria.

 

When antibiotic resistance develops, infection control and antibiotic stewardship to prevent the spread of resistant bacteria and the spread of legally infectious diseases must go hand in hand.

 

As in Korea, there is no need to reduce the use of antibiotics in a situation where fee-for-service, high access to medical care, and an increase in the number of elderly people exist.

 

It is easy to use antibiotics even for colds and to use for 3 days for 1 or 2 weeks.

 

Therefore, an organization that monitors antibiotic use and gives feedback is essential.

 

- Specifically, how to operate ASP =The Korean government is making phase 1 and phase 2 measures (national antibiotic resistance management measures) for antibiotic resistance.

 

Institutionalization of antibiotic stewardship is needed in earnest.

 

If there is no system, execution will not follow.

 

A system must be in place so that medical staff can accept feedback on why antibiotics must be managed and used sparingly, and why antibiotics are used a lot.

 

In general, an ASP team consists of a multidisciplinary team led by an infectious disease physician, a pediatric infection specialist, and a pharmacist specializing in infection, together with other departments (information computing team, clinical microbiology, medical quality control, infection control room, etc.).

 

In developed countries where the system is being operated first, nurses are often included in the number of dedicated personnel.

 

In overseas cases, large hospitals use a system that monitors antibiotics prescribed by doctors and supports prescriptions, checks the contents of prescriptions electronically, controls them when necessary, and gives feedback.

 

-Zerbaxa is a new drug that can reduce the use of carbapenem antibiotics.

 

It seems important to use new antibiotics well.

 

= Recently developed antibiotics are trying to prove their therapeutic effect on pneumonia such as complicated urinary tract infection, complicated intra-abdominal infection, ventilator pneumonia, and hospital-acquired pneumonia.

 

Zerbaxa has won these indications.

 

If Zerbaxa can be used regardless of whether or not ESBL is produced, the use of carbapenems can be reduced.

 

However, if the cost of using a new drug is high, carbapenem, which costs relatively less, will be used.

 

Of course, if the use of Dr.

 

Jeo increases, there are concerns about tolerance.

 

Because Dr.

 

Jeo has not yet been widely used, information on tolerance is lacking.