After surviving sepsis, medical student Liv Dumville has a newfound appreciation of the need to address the global health threat of antimicrobial resistance.
Liv Dumville writes:
“You know, if antibiotics didn’t exist, this would have killed you.”
These are jarring words to hear at any age, but as a 23-year-old medical student at the beginning of both my life and career, they were chilling.
Late last year, after ignoring back pain and malaise for nearly a week (you can blame this on my fixation of end-of-year exams), the onset of severe fevers that I couldn’t explain prompted a trip to the hospital.
I was quickly admitted to the Intensive Care Unit – reserved only for the most unwell of patients – to undergo treatment for sepsis.
Sepsis is a serious infection of the blood that has a high rate of mortality and morbidity; 5,000 Australians die from sepsis every year.
Young patients can recover well from sepsis – whilst our strong immune systems can trigger intense symptoms and fevers, if lucky, we are able to recover quickly and with little long-term impact. This was impressed to me frequently during my hospital admission, abating many of my fears that this infection may affect my quality of life in years to come.
Different fears have crept over me since my discharge from the hospital. I no longer have the worry that I won’t recover fully – I have been able to return to all my normal activities and have not noticed any persistent brain fog since I’ve returned to my studies.
Instead, I’ve been left with the lingering fear of what could have gone wrong had I not received the appropriate medical care.
What if?
More specifically – what would have happened to me if my antibiotics hadn’t worked? This question can be answered quite simply using those same jarring words I heard during my hospital stay: “If antibiotics didn’t exist, this would have killed you”.
This fixation of mine may seem irrelevant – antimicrobials do exist and in Australia are dispensed to the tune of over 21 million prescriptions a year. In fact, over the course of 2022, one-third of Australia’s population had at least one antimicrobial dispensed for them.
However, in the last few decades it has become increasingly clear to the medical industry and infectious disease specialists in particular that antimicrobial resistance is becoming prevalent at an alarming and dangerous rate.
Antimicrobial resistance has been repeatedly cited as one of the most significant global health threats in the 21st century, sitting amongst the ranks of pandemic outbreaks, climate change and the increasing incidence of noncommunicable diseases.
Antimicrobial resistance occurs when microbes that have previously been susceptible to certain medications develop a resistance mechanism that renders the drug ineffective.
Put simply, when bacteria, viruses, fungi and parasites become resistant to our medications, infections that were previously easily treated can quickly become deadly.
“AURA 2023” is a report published at the end of 2023 by the Australian Commission on Safety and Quality in Health Care (ACSQHC), summarising the latest data on antimicrobial use and resistance in Australia.
It documents resistance rates of common infectious microbes, whilst highlighting areas of inappropriate antimicrobial prescribing and use.
In residential aged care facilities, one-fifth of antimicrobials prescribed were for prophylaxis, and two-fifths were indicated as being for prolonged (six months or more) patient use; both practices are rarely recommended and are inconsistent with national guidelines.
In hospitals, nearly one-quarter of antimicrobial prescriptions were deemed inappropriate, with most of these involving the incorrect administration of antimicrobials before or after a surgery.
Finally, in the context of primary care it was found that over three-quarters of acute bronchitis cases – a common respiratory illness that is typically viral – were prescribed an antibiotic despite no direct evidence of benefit.
The report also notes that Australia’s rates of antimicrobial use are relatively high compared to other nations; in a group of 28 European countries as well as Canada, England and Scotland, Australia ranked fifth and seventh highest in hospital and community antimicrobial use respectively.
Whilst the number of annual antimicrobial prescriptions has decreased by 18 percent since 2019, Australia still clearly has much work to do to reduce inappropriate antibiotic use.
Counting the toll
Although its impact may seem invisible, make no mistake: antimicrobial resistance undoubtedly effects everybody in the community.
Common surgeries such as caesarean sections and joint replacements, as well as many cancer treatment regimens, require prophylactic administration of antimicrobials.
Without access to effective antimicrobials, these routine clinical procedures would become unsafe and put patients at significant risk of contracting potentially untreatable infections.
Additionally, doctors would have very few options when treating patients presenting with acute and life-threatening infections such as pneumonia, meningitis or sepsis (as was the case with myself).
Estimates show that by 2050, ten million global deaths per year will be attributed to drug-resistant infections, roughly on par with the current annual death toll from cancer. This estimate is nearly eight times greater than current figures; in 2019, 1.27 million deaths were caused by antimicrobial resistance.
These numbers also fail to reflect the economic burden that is associated with antimicrobial resistance in the global community. By 2050, deaths caused by antimicrobial resistance are expected to cost global economic output 100 trillion USD.
Antimicrobial resistance erodes the options we have to provide all members of our community with safe and effective healthcare and shouldn’t be treated as an issue that affects a minority.
Responses
I spoke to Professor John Turnidge AO – an infectious diseases physician, microbiologist and Senior Medical Advisor for the ACSQHC – to help me understand more about antimicrobial resistance and the difficulty we have as a nation in addressing the problem.
“There is an element of addiction to antimicrobials in Australia,” he told me. “[And] the problem with antimicrobial resistance is, it’s a slow burn – it takes a long time [to occur] and may not end up impacting any particular individual.”
When I have previously completed a student placement at a general practice in the outer suburbs of Melbourne, I noticed numerous patients expecting a prescription from their doctor, even where their symptoms don’t indicate the need for antimicrobials.
Whilst it may seem that a nation-wide public education campaign could help people understand when they do and don’t need antimicrobials, Turnidge doesn’t necessarily believe that this would be enough to address resistance.
“It’s a very big challenge to convince people they don’t need antimicrobials when they have the flu,” he said.
The medical profession also plays an understandably significant part in addressing the problem of antimicrobial resistance.
Currently in Australia, an antimicrobial stewardship program is mandatory for the accreditation of all hospitals, both public and private.
However, responsible antimicrobial use ultimately comes down to current clinical precedent and individual decision making by medical professionals.
“The problem with the medical profession is they’ve got the idea in their head that antimicrobials are harmless,” said Turnidge. “But they’re not. That requires a lot of re-education and new thinking in terms of future practice – focussing on young [doctors].”
What next?
Ultimately, Turnidge says: “It’s a dual responsibility”.
Patients must play an active role in the responsible stewardship of antimicrobials; this could involve asking their GP to explain why they need antimicrobials for a specific infection, or not continually requesting them where they are not indicated.
“Patients need to understand that antimicrobials aren’t useful for viruses. No – they don’t get you back to work or school more quickly.”
For doctors, “the first thing to consider is no antibiotics”. By staying up to date with clinical guidelines and challenging ‘common practice’, doctors can reduce the incidence of inappropriate or over-prescribing.
Additionally, doctors can act as a primary source of information and educate patients on antimicrobial resistance during relevant consultations. Whilst the COVID-19 pandemic provided an opportunity to educate the public that antibiotics cannot be used to treat viruses, this knowledge must be reinforced, Turnidge said.
It is important not to lose sight of the greater picture, in which both patients and doctors share a common goal – promoting the health, wellbeing and quality of life of all patients.
With antimicrobial development being one of the most prominent inventions of the 20th century, it would be a significant step back to lose the benefit of this life-saving medical discovery just one century later.
As a survivor of sepsis, it feels more important to me than ever to urge peers and friends to take the threat of antimicrobial resistance seriously.
“The question for everybody is – is an antibiotic really necessary? [It’s so] simple,” said Turnidge.
• Liv Dumville is a postgraduate medical student at the University of Melbourne with a longstanding passion for public health. She currently has particular interests in obstetrics, paediatrics and anaesthesia and hopes to specialise in and advocate for patients in one of these areas through a public health lens after graduating.
Previous articles by Liv Dumville
- For the upcoming generation of health workers, some reasons for hope
- Amid a national crackdown on vaping, what can be learnt from young people’s experiences?
See Croakey’s archive of articles on safety and quality of healthcare
