‘No clear focus on primary care’: CSIRO antimicrobial resistance report

Anastasia Tsirtsakis

1/03/2023 4:33:02 PM

While experts have welcomed the agency’s latest report, they say the emphasis on the role of general practice is lacking.

Multidrug resistant bacteria inside a biofilm.
There are concerns antimicrobial resistance could render some of the most critical antimicrobial drugs ineffective.

There is increasing urgency around the need to address antimicrobial resistance (AMR), with the World Health Organization ranking it as one of the top 10 public health threats facing humanity.
And the Commonwealth Scientific and Industrial Research Organisation (CSIRO), together with the Australian Academy of Technological Sciences and Engineering (ATSE), is ringing the alarm bell with a new report.
Entitled Curbing antimicrobial resistance: A technology-powered, human-driven approach to combating the ‘silent pandemic’, the report calls for greater national coordination to combat AMR, with a focus on streamlining commercialisation processes for new solutions and technologies.
Drawing on the expertise of more than 100 multidisciplinary experts, the report outlines potentially impactful technologies including:

  • integrated surveillance and sensing solutions
  • point-of-care diagnostics
  • vaccination technologies
  • antimicrobial surfaces
  • and air sterilisation technologies.
Among the specific examples are innovative solutions from surface sprays that change colour when pathogens are present to toilets that detect and disarm harmful microbes before they reach waterways.
Professor of evidence-based medicine at Bond University and GP, Paul Glasziou welcomes the attention being drawn to what is an ‘important and growing problem’, but has concerns about the report.
‘It is helpful … they rightly highlight the need to explore new technology options,’ he told newsGP.
‘However, the report barely mentions the importance of behavioural approaches, the need for antibiotic stewardship and the role of general practice as prescribers and stewards of antibiotics.’
As it stands, AMR is thought to be responsible for more than 1.27 million deaths globally each year, with estimates suggesting the number could skyrocket by 2050 to 10 million deaths annually, with a cost to the global economy of US$100 trillion (AU$1.4 trillion).
Currently in Australia, modelling suggests AMR is responsible for upwards of 5000 deaths annually.
AMR occurs when bacteria and other microbes become resistant to the drugs designed to kill them, such as antibiotics, usually from overuse or misuse.
Dr Mina Bakhit is a Postdoctoral Research Fellow at Bond University’s Institute for Evidence-Based Healthcare, with a focus on decision-making about antibiotic use in primary care.
He told newsGP the report does a very good job in highlighting all available evidence regarding AMR, including news and potential solutions, but agrees with Professor Glasziou’s take.
‘We totally understand that antibiotic resistance is quite a complex problem and [the report] needed to be targeted from all the different sectors using the one health approach,’ Dr Bakhit said.
‘[But] there is no clear focus on primary care … even though this is where most of the antibiotic prescribing is currently being done. It would have been better to highlight that.’
The report does highlight a few strategies and potential solutions relevant to general practice, such as point of care diagnostics in case of uncertainties, which are detailed in a series on AMR published in 2022 in the Australian Journal of General Practice, including a review of primary care’s role.
However, Dr Bakhit says there is more to it, particularly when it comes to patient demand for antibiotics and GPs navigating those discussions.
‘When we speak about AMR, the focus always goes to antibiotic prescribing because they are automatically linked. So, the first step would be to reduce antibiotic prescribing for acute self-limiting conditions,’ he said.
‘By doing that, it should reduce AMR indirectly.’
To tackle issues with antibiotic prescribing practices, the report highlights the application of ‘nudge theory’, which in Australia has seen personalised letters sent from the Chief Medical Officer to doctors with a track record of high antibiotic prescription rates.
While Dr Bakhit says there is some evidence that this approach can be effective, he says its success ultimately depends on how the letter is perceived by the individual GP. Rather, he proposes employing multiple proven strategies simultaneously, with GPs empowered to choose the right options for them and their patients.
‘[It] would help them more instead of pushing them to do a certain strategy, which from the evidence looks good, however, in practicality, it may not actually be easy to up-take in the day-to-day practice,’ he said.
Among the possible strategies is shared decision making, either with or without a decision aide, to help improve understanding and communication.
‘[This can] show the benefits and harms of antibiotics so patients would actually be more attracted to the no antibiotic option by balancing the pros and cons,’ Dr Bakhit said.
‘This would go along with patient information sheets highlighting that most acute infections go away on their own without the need for an antibiotic treatment and they could be managed. [But] that would be basically for low-risk patients, and we always depend on clinical insights from GPs and whether this patient actually needs an antibiotic.
‘However, whenever there is a diagnostic uncertainty or no clear benefit for the patient, strategies like shared decision making, delayed prescribing, point of care testing, all of that can help navigate a discussion with patients.’
Dr Bakhit says these strategies could have been better highlighted in the report.
Dr Branwen Morgan, who is the lead of CSIRO’s Minimising Antimicrobial Resistance Mission, is concerned that if the current trend continues unaddressed countries like Australia will return to the pre-antimicrobial age.
‘AMR could render some of the most critical antimicrobial drugs ineffective, undermining modern medicine and making us vulnerable to drug-resistant infections,’ she said.
‘This report calls out the key challenges and opportunities for Australia to improve how we prevent, detect, diagnose and respond to drug-resistant infections and reduce the impacts of AMR.’
When it comes to new technologies in the space, ATSE CEO Kylie Walker believes Australia has potential to be a global contributor, if not a leader, in their development.
‘We have a wealth of creative AMR technology solutions emerging in Australia,’ she said.
‘We must support these innovations through the commercialisation process so they can be delivered in the settings they are needed, in a streamlined, sustainable, and coordinated way.’
But to achieve this, Dr Morgan says the emphasis should be on both prevention and collaboration.
‘We aim to work with end-users, academic and industry partners to identify and prioritise solutions that have the greatest impact on preventing and managing further resistance,’ she said.
‘The report provides thought-provoking and multidisciplinary ways for organisations or groups to tackle the rising challenge of AMR.’
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FL   2/03/2023 6:41:00 AM

Can this report be used to stop politicians and pharmacists overselling and wasting antibiotics in dangerous trials like the UTI “ trial”?

Dr Keren Lee Witcombe   2/03/2023 10:37:26 AM

What about the massive amount of antibiotic use in hospitals and ED? And even that is dwarfed by antibiotic use in farming including fish farming and veterinary practice. Improved farming practices and less meat consumption will go a long way to solving this. Overseas antibiotics are often obtained without prescription and soon that will be the case in Australia. This issue is much bigger than general practice.