Ticking Time Bomb
East Asia has been identified by the World Health Organization (WHO) as an epicenter for the development of pathogens showing acquired immunity to the current armamentarium of modern antibiotics. With the upsurge in rapid international travel this has extremely worrisome global implications. In light of this, both popular news sources and medical journals speak to the need for supplemental medical education targeting antibiotic overuse and stressing the importance of evidence-based approaches to infection control.
For example, in December 2012, the Chinese Ministry of Health (MOH) reported that the average Chinese citizen consumes 138 grams of antibiotics annually (10 times the amount consumed per capita in the U.S.)and that some 70% of patients in Chinese Hospitals receive antibiotics. This can be directly compared with the WHO recommendation of a maximum of 30% antibiotic treatment of the same patient population.
While revenue generation clearly drives dangerous antibiotic overuse in some nations. Other healthcare deficits contribute significantly to the overuse/misuse problem. In a 2011 survey of 238 healthcare workers in 37 hospitals, Wen et al (2011) found that the overall hand washing compliance rate was only 32.38% and that rates varied considerably depending on the type of hospital. Handwashing compliance was still only 46.81% in tertiary care facilities (the biggest and best), 53.19% in secondary care hospitals, and only 7.69% in rural hospitals.1 In multiple regions, physicians are prescribing antibiotics without determining the pathogen responsible for the infection. In fact, one key survey of 108 hospitals conducted in 2010found that only 13.84% of patients had laboratory confirmation of the pathogen causing the infection before starting antimicrobial therapy. In an age when rapid international travel can spread antibiotic – resistant pathogens within hours and days this is one of the most serious problems confronting world health organizations to date.
A recent cross sectional survey of 890 Chinese Healthcare providers representing 32 of 34 provinces in China identified three clinical practice gaps that warranted immediate attention: first, professional unfamiliarity with common anti-infective practices, including active surveillance; second, a lack of education on specific infection control procedures; and third, a marked lack of evidence-based infection control practice.
With the World’s population now in excess of 7billion people, antibiotic over usage is a serious global threat, and if continued unchecked disastrously cripple infectious disease control worldwide. In 2011, Dr. Michael O’Leary of WHO reported “We are now on the brink of losing this precious arsenal of medicines. The speed with which these drugs are being lost far outpaces the development of new drugs.” Dr. O’Leary recommended several solutions that might help curb inappropriate use of antibiotics. Perhaps the most significant and executable of these was a call for educating physicians in several East Asian nations on the importance of strengthening surveillance laboratory capacity, improving regulation and promoting the rational and evidence-based use of essential medicines for infection control.
1 Wen Wei et al. Survey on Hand Hygiene Compliance at 37 Hospitals in Yichang City in 2011, China Journal Infection Control, Vol. 11, No 6, pp.425-429, Nov 2012.