Europe on alert over bacteria breaching man’s last defence

Antibiotic resistance in bacteria has increased steadily between 2012 and 2015, according to the latest report by the European Centre for Disease Prevention and Control.

Petri dish containing bacterial culture being examined in a microbiology lab. Roughly 25,000 people die every year in Europe because of infections by drug-resistant bacteria, according to World HealthShow more

DUBLIN // Immigration controls into Europe may be famously tight, but they are of no use when it comes to a class of organisms that knows no borders: drug-resistant bacteria.

A report from the European Centre for Disease Prevention and Control (ECDC), released on Friday, showed that antibiotic resistance in bacteria increased steadily between 2012 and 2015.

Most worryingly, bacteria were beginning to resist carbapenems, a group of antibiotics that is the last line of treatment for drug-resistant pathogens. With Klebsiella bacteria, which causes several respiratory infections, for example, 8.1 per cent of samples studied proved resistant to carbapenems, up from 6.2 per cent in 2012.

“Antibiotic resistance is one of the most pressing public health issues of our time,” said Vytenis Andriukaitis, the European commissioner for health and food safety. “If we don’t tackle it, we can go back to a time when even the simplest medical operations were not possible, and organ transplants, cancer chemotherapy or intensive care even less so.”

Roughly 25,000 people die every year in Europe because of infections by drug-resistant bacteria, according to World Health Organisation statistics.

Mr Andriukaitis said his agency planned to launch an action plan against antibiotic-resistant bacteria next year.

Besides Klebsiella, resistant strains of Escherichia coli are of particular concern. The ECDC report found that the proportion of E coli bacteria resistant to third-generation cephalosporin antibiotics rose from 11.9 per cent in 2012 to 13.1 per cent last year.

Within Europe, rates of antibiotic resistance vary. In southern and south-eastern Europe – Greece, Italy, the Czech Republic – the occurrence of drug-resistant bacteria infections is higher. Given the lack of border controls in much of Europe, travellers can easily carry such bacteria from one country to another, widening the range of these pathogens.

But bacteria can also reach Europe from regions in Asia and Africa, which exhibit far higher concentrations of drug-resistant bacteria, said Frieder Schaumburg, a medical microbiologist at the University Hospital in Munster, Germany.

Along with colleagues in Munster and at the Robert Koch Institute in Berlin, Dr Schaumburg studied the incidence of drug-resistant bacteria on the door handles of toilets at international airports around the world.

“We thought this was the best place that can be sampled to assess the bacteria that is imported by travellers from other countries and regions,” Dr Schaumburg told The National.

Between 2012 and 2015, 39 volunteers collected samples from door handles inside the stalls at airport toilets every time they travelled overseas. The team collected 400 swabs from 136 airports in 59 countries.

Sylvia Schaber, a doctor at University Hospital served as one of the volunteers. Last year, during trips to Paris, New York and Warsaw, she would go to a toilet, take out one of the moistened cotton swabs Dr Schaumburg had given her, and run it across the door handle.

No one saw her doing this, since she swabbed the handles inside the toilet stalls, Dr Schaber said. “But it was a funny feeling, taking out these swabs. You thought that if someone saw you, of course they would be asking themselves what you’re doing.”

The results of the study, published in September by the journal Clinical Microbiology and Infection, showed bacteria from all over the world coating these toilet door handles. “You don’t need to travel to South-east Asia to acquire a pathogen from South-east Asia,” Dr Schaumburg said.

The researchers found four strains of bacteria that were resistant to one antibiotic but vulnerable to others. It was only in one sample that they detected a bacteria strain resistant to several antibiotics.

This strain of Methicillin Resistant Staphylococcus aureus (MRSA), known to cause a range of potentially fatal infections, was isolated from a toilet door in Paris. By examining the bacteria’s genetic make-up, the researchers determined that the MRSA strain probably originated in India or neighbouring countries in South Asia.

Since the study returned only one positive swab out of 400, Dr Schaumburg said, the conclusion was that airport toilet door handles were not potent bacteria carriers. But the results still demonstrated “proof of principle”, showing that drug-resistant bacteria are carried around the world by travellers.

Even if these bacteria are not passed on via bathroom surfaces, he said, they can be transferred by other forms of contact or through the air.

Part of the reason that bacteria develop resistance to drugs is an overuse of antibiotics. Especially in countries like India, where “you can buy antibiotics without prescription, and even doctors prescribe antibiotics too casually”, said N K Ganguly, a microbiologist who chaired the Indian working group of the Global Antibiotic Resistance Partnership.

“They give out antibiotics for the common cold, antibiotics for sore throats,” Dr Ganguly said. “So the bacteria have more chances to develop resistance.”

As a result, Dr Schaumburg said, “the number of drugs that can be used to treat these bacteria is decreasing very, very quickly”.

If bacteria become overwhelmingly resistant even to carbapenems, “if we lose this last weapon, there is probably not more we can do than just pray”.