“Worrying” antimicrobial resistance in Adelaide aged care home

A small wastewater sample analysis of three Adelaide aged care homes revealed two have residents with concerning levels of bacterial resistance against antibiotics.

The study of 300 residents published last Wednesday found one home had high antimicrobial resistance (AMR) against ceftazidime, cefepime and ciprofloxacin, and another had above-average levels of resistance to gentamicin.

These medications are used to treat infections such as pneumonia, urinary and respiratory tract infections, and other health issues like bone and joint pain.

AMR is mainly caused by the overprescription of antibiotics, which allows bacteria in the body to slowly build resistance to the drugs, while the medication also destroys good bacteria that fight disease.

Researcher Dr Rietie Venter, associate professor of clinical and health services at the University of South Australia, said these findings highlighted the need for surveillance of possible antibiotic misuse.

"Antimicrobial resistance is projected to lead to 300 million deaths worldwide by 2060, and aged care residents are among the most vulnerable due to frequent, inappropriate use of medicines," Dr Venter said.

"[The resistance can also] lengthen illness recovery times, especially for immunocompromised people who make up a high proportion of people in aged care homes."

The study was limited to three aged care homes of the same provider so the same systems and types of care could be accurately compared.

Due to privacy reasons, the name of the aged care provider cannot be disclosed.

Dr Venter said water-waste sample analysis is uncommon in the industry because working with a large amount of samples from residents, the facilities and their wastewater can be exhaustive and time-consuming.

Data from these three facilities have been analysed as part of a larger study to investigate the antimicrobial resistance of residents, which Dr Venter should be a clear warning to aged care facilities to implement stricter policies when it comes to medication use to mitigate the threat of AMR.

The Australian Health Care Commission has its own Antimicrobial Use and Resistance in Australia Surveillance System (AURA), which found that not many rates of resistance have changed since 2019 samples were taken, and some have even decreased.

However, resistance rates for certain diseases, such as E. coli and salmonella, have increased in the past 10 years.

The World Health Organisation (WHO) found evidence of resistance to antibiotics in a 2014 report and said AMR is a serious threat that is happening now and can affect anyone in any country.

Antibiotics studied by the WHO in this report are used to treat infections such as bloodstream poisoning (sepsis), diarrhoea, pneumonia, urinary tract infections and gonorrhoea; which are all common, but serious, diseases.

WHO’s Assistant Director-General for Health Security, Dr Keiji Fukuda, said significant action is needed to change how [medical professionals] prescribe and use antibiotics.

"Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill," Dr Fukuda said.

Australia's national AMR strategy is a 20-year framework that aims to 'protect the health of humans, animals and the environment through minimising the development and spread of AMR while continuing to have effective antimicrobials available'.

The strategy is driven by the need for clear and collaborative regulation of antibiotics by all Australian governments and calls on all private and public businesses to review if their prescription drug handling could contribute to increasing AMR.

Dr Venter told Aged Care Insite this was just an initial study, and she looks forward to analysing samples from other aged care facilities.

The expert said she is now working with the aged care facility to effectively implement infection control to prevent potential outbreaks of infections caused by antimicrobial-resistant organisms.

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