Patients Showing Resistance to Antibiotics in Recent Years

Ms Joan Pereira asked the Minister for Health (a) how many patients have shown resistance to antibiotics over the last three years; (b) what are the profiles of these patients; and (c) what measures are being implemented in 2019 to educate target groups about the correct use of antibiotics.

Antimicrobial resistance or "AMR" is a commonly occurring phenomenon, where microorganisms change and develop resistance after being exposed to antimicrobial drugs.  However, the excessive and inappropriate use of antimicrobials has exacerbated its development. Today, AMR has been observed across a range of diseases, from common respiratory and urinary tract infections, to more serious diseases such as tuberculosis, malaria and sexually transmitted diseases like syphilis. Treatment for resistant infections often involves newer generation drugs that are usually more expensive, require longer duration of treatment or lengthier stay in hospitals, and sometimes with potentially more side effects.

AMR in the community such as those treated in the GP setting is not centrally tracked. In our public hospitals, AMR is monitored through indicators on infection by the bacteria, methicillin-resistant Staphylococcus aureus or "MRSA" – a resistant infection common in the hospital setting, and carbapenemase-producing Enterobacteriaceae or "CPE" – a more recent form of antimicrobial resistance of emerging concern globally.

The infection rate of MRSA has dropped from 17.6 per 10,000 inpatient days in 2011, to 10.6 per 10,000 inpatient days in 2018. Between 2015 and 2018, CPE infection rates here have hovered around 0.9 per 10,000 patient days per year.

Individuals with weakened immune systems and those who require invasive procedures or medical devices are more vulnerable to AMR infections. A study of patients in public hospitals infected with CPE found that the median age was 66 years old and many had chronic diseases such as diabetes or heart disease. AMR is often exacerbated by the inappropriate and overuse of antibiotics. About three quarters of these patients had used antibiotics in the preceding 30 days.

Antibiotics should only be prescribed when necessary. Antimicrobial Stewardship Programmes have been implemented in all public hospitals since 2011 to guide doctors on appropriate antibiotic use, so as to slow down the emergence of AMR. Recognising that a long-term multi-prong approach is necessary to address AMR, the National Strategic Action Plan was launched in 2017, to reduce and prevent the spread of AMR through the five key pillars of (i) Education; (ii) Surveillance; (iii) Infection Prevention and Control; (iv) Optimisation of Antimicrobial Use; and (v) Research.

Under the pillars of Education and Optimisation of Antimicrobial Use, the National Centre for Infectious Diseases is working on professional education efforts, such as training programmes and guidelines on the management of infections and antimicrobial use.

Patients too have an important role to play in the appropriate use of antibiotics. In 2018, the Health Promotion Board launched the annual "Use Antibiotics Right" public education campaign to address the general public misperception that antibiotics are needed for minor ailments, such as the common cold or flu, and to encourage patients to discuss with their doctors the necessity for antibiotic use. Patients are also reminded to follow the instructions given by their doctors on their prescribed antibiotics.

We will continue to work with all stakeholders to tackle AMR as everyone has a part to play.