Multi-resistant bacteria want to conquer the world

Bacteria lurk everywhere: on the skin, in the intestines and in every puddle. Most of them that are hanging out in the human body are good bacteria. But not all of them. Those pathogens that exhibit resistance and are thus very hard to combat are the most dangerous kind. Their spread threatens people all over the world.


Graphic: Spherical bacteria; Copyright:

Among the most common multiresistant pathogens include MRSA, ESBL-forming K. pneumoniae and E. coli, and VRE; © royaltystockphoto

Multi-resistant bacteria (MRB) usually result from the incorrect use of antibiotics. Normally, our immune system is able to successfully protect our body against germs that are always on and in it. Yet as soon as the body is weak or injured, the risk of infection increases. Antibiotics are often used if that is the case. However, only the right dose and the right duration for these drugs can result in a successful treatment.

If antibiotics are stopped too soon, it might happen that not all germs have been killed off. Those that survived build up a resistance to the given antibiotic; they proliferate and pass down their adaptability to the next generation. Thanks to the increased use of antibiotics in humans and animals over the past few years, several bacterial species have changed to where they have become resistant to many of the commonly used antibiotics. They have become multi-resistant bacteria.

MRB in Germany

According to a study by the European Center for Disease Prevention and Control, abbreviated ECDC, the risk of infection in German hospital facilities is significantly lower than in many of its neighboring countries and ranks about five percent. However, the study also shows that there is a considerable lack of trained personnel, who ensure hygiene standards. That’s why the Association of Scientific Medical Societies (German: Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) recommends the creation of interdisciplinary antibiotic stewardship (ABS) teams like the ones already established in the U.S., the Netherlands or in Sweden for instance. The team consists of an infectious disease specialist, a specialty pharmacist as well as specialists in microbiology of the hospital. The duties and responsibilities of an ABS team include the development of applicable local guidelines for antibiotics use in the hospital. It also provides education and further training of personnel and collects data on antibiotics use and hospital infection rates.

There is also a need to catch up as it pertains to hand disinfection in German hospitals, which rank somewhere in the middle compared to other European nations. According to the study, the lack of carefully and routinely trained staff is the culprit. This is why a hospital hygiene law passed in 2011 obligates the German federal states to introduce hygiene regulations. Consequently, law mandates the use of hygiene specialists.
Photo: Physician is washing his hands; Copyright: Marcinski

Still too many pathogens are transmitted through the hands of the hospital staff. Hand disinfection plays an enormous role in the prevention of infections; © Piotr Marcinski

MRB internationally

In April of 2014, the World Health Organization WHO published an extensive report on the global spread of multi-resistant bacteria. It analyzed data from 114 countries and produced a serious view of the situation in all regions of the world. In both Africa and the American continents, Staphylococcus aureus in particular, which is resistant to methicillin (MRSA), presents an explicit threat. The significantly increasing Escherichia coli and Klebsiella pneumoniae resistance is also mentioned as very alarming.

Based on the report, many European countries have national and international surveillance systems that regularly collect and analyze data on antimicrobial resistance and in doing so, keep spreading resistance comparatively well under control. Nevertheless, there are weak spots, especially in the Eastern regions. This is why the Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network was founded. It is confronted with the task to develop new systems in the respective countries, so the collected data can be compared on a global basis.

Across borders

In times of limitless travel options, multi-resistant bacteria also know no bounds. Many German hospitals therefore collaborate with neighboring hospitals abroad and in doing so try to retain control over infection rates. There are different guidelines and recommendations for the use of antibiotics and the handling of multi-resistant bacteria in almost every individual country. Researchers from Germany and the Netherlands have already collaborated for several years and are developing different strategies in the EurSafety Health-net project to minimize the spread of bacteria in hospitals. On the other hand, collaboration with the Polish EMC Medical Institute began in May 2014 in Greifswald. The goal is a cross-border cooperation to achieve joint MRB management.

Multi-resistant bacteria pose a serious threat to people all over the world. Purposeful and expert use of antibiotics is necessary to minimize this risk. Specific hygiene measures in medicine are also extremely important to control the spread of bacteria and their resistance. However, it is not just institutions such as hospitals and their staff that must comply with specific hygiene regulations. Each one of us helps to keep the spread of dangerous bacteria under control by simply washing our hands and strictly following a physician’s instructions for antibiotics use. And it helps to prevent bacteria from taking over our world.
Photo: Michalina Chrzanowska; Copyright: B. Frommann

©B. Frommann

The article was written by Michalina Chrzanowska and translated from German by Elena O'Meara.