BEIRUT: Lebanese doctors are warning about the consequences of an alarming increase in bacteria that is resistant to the strongest antibiotics, with a report by the World Health Organization highlighting startling rates of resistance in Lebanon and worldwide.
The misuse and abuse of antibiotics must be strongly cut back, or else patients risk being defenseless against increasingly powerful microbes, doctors say.
“The situation is quite threatening and alarming,” said George Araj, the director of clinical microbiology at the American University of Beirut whose research findings were cited in the WHO report. “Against certain bacteria we are losing the battle.”
In a massive report released in late April, the WHO found “very high rates of resistance” in bacteria that is responsible for common infections like pneumonia and urinary tract infections worldwide.
The WHO report also highlights “significant gaps” in surveillance or collection of data on resistance to antibiotics around the world.
Bacteria can adapt and become resistant to antibiotics if the medication is abused. This antimicrobial resistance is dangerous because it threatens to render obsolete most common forms of treatment of illnesses like pneumonia that can be lethal if untreated.
The report showed high rates of resistance for a variety of microbes, including those responsible for tuberculosis, HIV, malaria, pneumonia and influenza.
In Lebanon, over half of E. coli bacteria were found to be resistant to fluoroquinolones, an important type of antibiotic, while up to a third of bacteria in a 3,800 sample study between 2010 and 2011 were found to be resistant to a type of third-generation antibiotic.
About a quarter of a type of bacteria responsible for pneumonia that was collected from a hospital in Lebanon were found to be resistant to third-generation antibiotics.
In addition, over a fifth of Staphylococcus aureus bacteria, which cause skin and other infections, were found to be resistant to methicillin, a derivative of penicillin.
Araj said there were also rising numbers of cases of tuberculosis that are resistant to treatment.
The WHO findings come just a few months after a major report by the United States Centers for Disease Control and Prevention, which warned that humanity may enter a “post-antibiotic era” if current resistance trends continue.
Most of the Lebanon-related figures in the report came from independent studies by Araj and others, because of a paucity of national data.
Araj said that there are no national figures on antibiotic resistance, but he is collaborating with Rola Husni-Samaha, the President of the Lebanese Society for Infectious Diseases and Clinical Microbiology, on a project to collect data from hospitals around the country.
The project will help fill the gaps in the data that was initially supposed to be gathered by a ministerial committee on AMR that has not seen much progress.
AUBMC itself has been distributing brochures intended for physicians and health care professionals on antibiotic resistance since the early ’90s, profiling bacteria that were beginning to exhibit signs of resistance to medication.
But despite awareness efforts, Araj said, bacteria are growing increasingly resistant to antibiotics.
In a landmark paper published in the Lebanese Medical Journal in 2012, which was cited in the WHO report, Araj and his team set out to examine AMR in bacteria infecting patients of all categories, ages and regions in a major Lebanese hospital over several years in order to study and monitor its evolution.
The results, which were reproduced in the WHO report, found a rise in resistance to antibiotics among various types of bacteria, including E. coli and microbes responsible for infecting patients with pneumonia.
Some of the bacteria had developed genes resistant even to carbapanems, a powerful and expensive form of medication that is not readily available and which Araj described as the “heaviest guns” of treatment.
Araj said that several factors are contributing to the rise in resistance. Patients from other countries in the region with fewer controls on the use of antibiotics have introduced more resistant strains into Lebanon over the past decade.
But “misuse and abuse” of antibiotics in Lebanon is also benefiting microbes, allowing them to adapt to antibiotics and develop resistance.
“The bacteria are very intelligent,” he said.
Both doctors and patients are guilty of poor practices. Physicians overprescribe antibiotics to patients, even when they suffer from viral infections that are not remedied by antibiotics, such as most respiratory illnesses.
Such educational efforts should be extended to all medical staff, including pharmacists, clinicians, nurses and administrators at hospitals, he said, as part of a national strategy to fight antibiotic resistance.
Patients, on the other hand, often pressure doctors into prescribing antibiotics or they decide to take them without consulting physicians. Not completing a course of medication prescribed by a doctor, even if a patient feels cured, can also contribute to increasing resistance.
In addition, antibiotics should no longer be available over the counter at pharmacies, Araj said, and hospitals need to develop complete infection control programs.
If reforms are not implemented, Lebanon, along with the rest of the region, will likely face dire consequences. “Genuine effort should be dedicated or we will lose the battle and our patients will be suffocated,” Araj said.
He added that the most vulnerable patients to this rising class of powerful, resistant bacteria will be individuals with weak immune systems – among them children and the elderly, cancer patients, and transplant patients.