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Antibiotic resistance and policy in Belgium
1Laboratory for Microbiology, University Hospital Antwerp, University of Antwerp, Universiteitsplein 1-B 2610 Wilrijk-Antwerpen.
Abstract:
Antibiotic resistance is increasing worldwide, also in Belgium. A few examples to illustrate this problem: S. pneumoniae are becoming increasingly resistant to penicillin and erythromycin; resistance of S. pyogenes to erythromycin is increasing year-by-year; Salmonella and Campylobacter are becoming more and more resistant to the fluoroquinolones. In hospitals, the problem of methicillin-resistant Staphylococcus aureus appears to be decreasing, but two clones of ceftazidime-resistant Enterobacter aerogenes are spreading throughout the Belgian hospitals. Antibiotic resistance has become a serious health care issue both in hospitals and in the community. The popular press has termed some of the multiresistant organisms "killer bugs" or "superbugs". Infection with such organisms has been associated with treatment failures, higher morbidity and mortality and increased costs. In this paper, we will review the problems of antibiotic resistance in the community setting. We will briefly discuss those pathogens with important consequences of morbidity and mortality in the community, such as: Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis, the enteric pathogens Salmonella and Campylobacter, and the urinary tract pathogen E. coli. This resistance has in response to various conditions and opportunities, such as: clustering and overcrowding, increased number of immunodeficient patients, increased elderly population, population mobility, increased use of (broad-spectrum) antibiotics, over-the-counter sale and self-dosing with antibiotics, inappropriate antibiotic prescriptions and lack of compliance, fewer resources for education and infection control, decreased funding for public health surveillance. In Belgium, we should be able to develop, implement and evaluate a good antibiotic policy. Our country has a wealth of information on antibiotic consumption in hospitals and the community. This information has been used for benchmarking of antibiotic consumption in hospitals. A unique system for reimbursement of prophylactic use of antibiotics in surgery was developed which resulted in a more adequate use of antibiotics. However, a policy should not be limited to the human ecosystem. Therefore, a Coordination Commission for Antibiotic Policy was installed recently by the Ministers of Social Affairs, Public Health and Agriculture.
Insights
Antibiotic resistance is a growing global threat, impacting Belgium with resistant bacteria like Streptococcus pneumoniae and Salmonella. Urgent antibiotic policies are needed to combat this public health crisis.
Area of Science:
- Public Health
- Infectious Diseases
- Microbiology
Background:
- Antibiotic resistance is a significant and escalating global health concern.
- Specific pathogens like Streptococcus pneumoniae, Streptococcus pyogenes, Salmonella, and Campylobacter exhibit increasing resistance to common antibiotics.
- Multidrug-resistant organisms, termed "superbugs," are associated with treatment failures, increased morbidity, mortality, and healthcare costs.
Purpose of the Study:
- To review the challenges posed by antibiotic resistance in community settings.
- To discuss key pathogens contributing to morbidity and mortality in the community.
- To identify factors driving antibiotic resistance and explore policy development in Belgium.
Main Methods:
- Review of existing literature on antibiotic resistance patterns.
- Analysis of contributing factors to resistance, including healthcare practices and societal trends.
- Examination of current antibiotic consumption data and policy initiatives in Belgium.
Main Results:
- Increasing resistance observed in Streptococcus pneumoniae to penicillin and erythromycin, and in Salmonella and Campylobacter to fluoroquinolones.
- While methicillin-resistant Staphylococcus aureus (MRSA) may be decreasing in hospitals, specific resistant Enterobacter aerogenes clones are spreading.
- Factors contributing to resistance include overcrowding, immunodeficiency, an aging population, population mobility, and inappropriate antibiotic use.
Conclusions:
- Antibiotic resistance presents a serious healthcare issue in both hospital and community environments.
- Effective antibiotic policies are crucial for Belgium, leveraging existing data on consumption and implementing coordinated strategies.
- A comprehensive policy must address the human ecosystem and involve inter-ministerial coordination, as evidenced by the recent establishment of a Coordination Commission for Antibiotic Policy.