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Wastewater confirms high level of antimicrobial resistance in aged care
More than 90 resistant E. coli isolates were identified from just three facilities, suggesting concerning rates among one of Australia’s most vulnerable groups.
Wastewater analysis reveals antimicrobial resistance in aged care facilities
New research published in the Microbiology Spectrum has revealed concerning rates of antimicrobial resistance in Adelaide’s residential aged care facilities.
Antimicrobial resistance is considered one of the top threats to global health by the World Health Organization and is largely driven by the antibiotic overuse that leads to bacteria changing over time and no longer responding to previously effective treatments.
Lead researcher of the study Associate Professor Rietie Venter from the University of South Australia told newsGP that resistance patterns in aged care facilities represent an important challenge and monitoring emerging resistance has been limited in this setting.
‘Given our ageing population, there is a crucial need to regularly monitor these facilities and mitigate the threat of antimicrobial resistance,’ she said.
‘High and sometimes inappropriate antibiotic use has been documented for residential aged care facilities. As a result, these facilities could represent selective environments favouring the development of antimicrobial resistance.’
Associate Professor Venter’s team analysed samples of wastewater from three facilities and found unique patterns of antimicrobial resistance in each location, which may be related to whether or not antimicrobial stewardship programs have been implemented.
By analysing the wastewater of around 300 residents over an 18-month period, the researchers were able to isolate strains of E. coli and determine phenotypic and genotypic resistance. Following this process, the ‘antimicrobial resistome’ of each water sample was uncovered.
The sensitivity of E.coli was identified for multiple antibiotics, including cefepime, ceftazidime, piperacillin-tazobactam, gentamicin, meropenem, trimethoprim-sulfamethoxazole and ciprofloxacin – a total of 93 resistant E. coli isolates were identified in the study.
The aged care facility that did not have an antimicrobial stewardship program was found to have higher levels of antimicrobial resistance and a higher prevalence of mobile resistance genes that can potentially be transmitted to other bacteria.
‘The results of this study highlight the need for ongoing surveillance of residential aged care facilities when it comes to medication use,’ Associate Professor Venter said.
According to the most recent report from Antimicrobial Use and Resistance in Australia Surveillance System, around 10 million people in Australia are prescribed at least one antibiotic every year under the PBS, representing approximately 40% of the population.
The report highlights that antimicrobial resistance is projected to lead to more than 10,000 in Australia between 2015 and 2050, and is calling for ‘an urgent re-focusing by all prescribers to align with national and state and territory guidelines for antimicrobial prescribing’.
Chair of RACGP Specific Interests Aged Care Dr Anthony Marinucci told newsGP the research findings add to a growing body of evidence related to prescribing patterns.
Dr Marinucci says that prioritising antimicrobial stewardship programs that promote ‘careful and responsible management of medications used to treat or prevent infections’ is key in addressing the issue.
‘Successive Aged Care National Antimicrobial Prescribing Survey reports show that antimicrobials are being used in aged care for conditions where they are not required, of inappropriate duration or for prevention of infection, all leading to an increased risk of antimicrobial resistance,’ he said.
‘Further, we have evidence that antimicrobial resistance rates are higher in aged care services than in hospitals.
‘Antimicrobial stewardship is a multidisciplinary approach to promoting and supporting best practice antimicrobial prescribing [and] should remain a focus for quality improvement in aged care.’
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