We Can’t Cleanse Populations of Antibiotic Resistant Organisms
By Jim Hutchinson, MD, FRCPC, Memorial University of Newfoundland

The current infection control mantra advocating actively seeking out the humans harbouring antibiotic resistant bacteria and “decolonizing” them with antibiotics is fabulously flawed and short-sighted. More antibiotics will certainly not be a fix for the complex problem of antibiotic resistance.

There will always be bacteria circulating in human populations. Staphylococcus aureus, Streptococcus pyogenes and Strepococcus pneumoniae have been living in and on humans since the inception of humanity. When a new or “re-circulated” type (strain) enters a population, as is happening now with so-called community-associated MRSA (USA type 300 or Canadian type CMRSA10), some people will become ill with relatively minor illness. An unfortunate few will have serious illness. Many more will become immune without illness. The strain will spread widely and over time will appear to be less virulent (able to cause disease) as the immunity of the population increases. It will be transmitted less efficiently as there will be fewer people with overt disease and fewer susceptible individuals. Another strain will emerge that has an advantage and the complex story will write its next chapter.

It is simply not possible to fundamentally change this circumstance by focussing on the individual “bad” organism and killing it with more antibiotics. While “de-colonizing” has a well-defined benefit in particular circumstances (the use of antiseptics and antibiotics prior to surgery is the best example), it certainly can’t be viewed as a rational public-health response to a continuously changing world-wide ecologic problem. The extreme efforts focusing on individual organisms are stifling the debate on fundamental solutions for managing (not eliminating) antibiotic resistance and infections caused by antibiotic resistant micro-organisms. Firstly, we need much more attention to antibiotics at all levels. Programmatic approaches to optimizing their distribution are essential. Secondly, we need a major renewal of healthcare infrastructure engineered to limit the spread of micro-organisms. There is absolutely no reasons why Canadians can’t address these issues and become a world leader.

The antibiotic resistance file must be elevated on all agendas.