Dr. Andreas Glöckner has been employed by OPHARDT Hygiene as Medical Director since August 2017. Thanks to more than 25 years of experience as a specialist for Internal Medicine and as an infection and intensive care specialist he knows too well the typical challenges of multidrug-resistant bacteria.
In a personal interview he reports on why the increase in multi-resistant pathogens is a direct result of inadequate antibiotic use and poor hand hygiene.
Markus Theißen: What are multidrug-resistant pathogens and what are the causes of the emergence and spread of these resistant bacteria?
Dr. Andreas Glöckner: In the case of multi-resistant pathogens, MRE for short, several or, in extreme cases, all otherwise effective antibiotics can no longer kill these pathogens.
The cause of MREs is indiscriminate antibiotic (AB) therapy at several levels. Frequently, ABs are not properly used. They are overused for viral infections or for prophylaxis without justification. Or the wrong agent or the wrong dosage is used—usually underdosed so that the therapy runs too long. A basic principle of anti-infective therapy—to optimize treatment once we learn about the pathogen and resistogram—is too often forgotten.
Excessive use of antibiotics in animal husbandry also plays a major role; raw meat is a large reservoir for MRE. Insufficient hand hygiene plays the main role in the spread of these pathogens, which can then reach the patients via staff and lead to an infection.
Markus Theißen: What makes these germs so dangerous?
Dr. Andreas Glöckner: Their explosiveness is due to the significantly limited treatability of these often life-threatening infections. In some cases, resistance to all otherwise effective antibiotics is detected by the laboratory, which of course considerably reduces the chances of a cure. The lethality of infections with these highly resistant germs is significantly higher than for those with sensitive pathogens.
MRSA decreased, gram-negative bacteria increased
Markus Theißen: How do you assess the situation and the development?
Dr. Andreas Glöckner: Gram-positive MRE, especially MRSA – a skin germ, have decreased, but Gram-negative MRE, especially intestinal germs, are on the rise. This is problematic because Gram-negative pathogens have much more complex resistance mechanisms and the portfolio of usable AB is very limited. There is no drug that is effective for all pathogens and all types of infection, nor is such a drug in the pharmaceutical industry’s pipeline.
Markus Theißen: Do you have figures for us on how often antibiotic-resistant infections occur and how high the risk of dying from them is?
Dr. Andreas Glöckner: Extrapolated to Germany, a representative study shows that 31,000 patients per year suffer a hospital infection with a multidrug-resistant pathogen, and 2,100 die from it, i.e. just under 7%, which means that the lethality is about twice as high as for infections with sensitive pathogens.
A study just published in The Lancet also shows how big the problem is. According to this estimate, more than 1.2 million people worldwide died from infection with multidrug-resistant germs in 2019. For another nearly five million people, such an infection was partly responsible for their death.
Hand hygiene with key role to fight against multidrug-resistant bacteria
Markus Theißen: How can we contain the further spread?
Dr. Andreas Glöckner: Simply put, by eliminating the causes, but this is a very complex undertaking. Above all, hand hygiene compliance and the quality of hand disinfection must improve significantly to minimize the transmission of MRE. Furthermore, the use of AB must be significantly optimized and its use in agriculture must be curbed.