Antibiotic resistance: how did we get here and what can we do?

Abstract

Executive summary Does antibiotic resistance exist? Yes. It is a worsening phenomenon seen all over the world, including Australia. What are the implications of antibiotic resistance? Infection with antibiotic-resistant bacteria is associated with longer length of stay in hospitals and higher death rates. This amounts to significant financial costs; the European Union, for example, spends €1.5 billion annually on antibiotic-resistant infections. Significant indirect costs can also arise from antibiotic-resistant infections when they adversely affect other areas of medicine, for example, transplant medicine, surgery and chemotherapy. How did we get here? Antibiotic resistance has many causes but the most important ones include: excessive and inappropriate antibiotic use among humans and animals (including ‘over-the-counter’ antibiotic use), global trade, global travel, medical tourism, environmental contamination with antibiotics, and a decline in new antibiotic development. What can we do? Because there are multiple causes, a multi-pronged solution is required. The ‘EVADES BUGS’ strategy seeks to address the core problems: Education, Vaccine development, Animal health, Diagnostics, Environmental controls, Surveillance, Better antibiotics, Universal infection control and hand hygiene, Government and political will, Stewardship of antibiotics in hospitals. Many superbugs arrive here from overseas as a consequence of global trade and global travel. As a result, Australia must play a global role in addressing the issue as well as a local one. Implementing the EVADES BUGS strategy would require activity across portfolios (for example, Health, Trade, Agriculture, Environment, Tourism, Customs). Therefore, it is worth considering the establishment of a single coordinating body, such as an Australian Centre for Disease Control, to take responsibility for the strategy as part of a broader focus on monitoring and responding to communicable diseases.