Amount of consumption of antibiotics by South Korean residents is very high as it is 1.63 times the OECD (Organisation for Economic Cooperation and Development) average in 2017. Antibiotic use is rampant as they are prescribed antibiotics even for minor cold. Human antibiotics are not the only problem. Antibiotics that are used recklessly on animals have come back to haunt humans. There is a research that shows when a person eats meat that is infected with bacteria (super-bacteria) resistant to antibiotics, he or she can have negative effects from eating such meat.
There has been a rapid increase in number of cases of Infection by super-bacteria from reckless use of antibiotics. In this year alone, number of patients doubles that of last year. Fundamental measure is to lower antibiotic use. Infection management and development and supply of appropriate medicines need to take place at the same time. However, hospitals complain about lack of costs to establish infrastructures for infection. Pharmaceutical companies give up on development of medicines due to absurdly low price of medicine. National measures are urgent to take measures against super-bacteria that is one of the biggest threats that mankind is currently facing.
◊Infection by super-bacteria doubles within a year
Number of cases of infection by super-bacteria in South Korea is rising rapidly. As there has been a discovery of new super-bacteria resistant to antibiotics and infection management has tightened up, number of reports on infection cases has also increased as a result.
There are CRE (Carbapenem-Resistant Enterobacteriaceae) and VRSA (Vancomycin Resistant Staphylococcus Aureus) that are required to be reported by every medical office according to current national infectious disease management regulations. Most of super-bacteria infections in South Korea is caused by CRE.
According to Korea Centers for Disease Control & Prevention’s Infection Disease Portal, number of reports of people infected with CRE doubled from 5,716 in 2017, when reporting of people infected with super-bacteria became an obligation, to 11,911 in 2018. In 2019, there are currently 3,948 patients infected with super-bacteria.
“Excluding VRSA, there has been a consistent increase in number of people infected with CRE in South Korea.” said Department Head Lee Hyung-min of Korea Centers for Disease Control & Prevention’s Medical Infection Management Department. “While other countries are showing a downward trend after seeing an upward trend for two to three years, there has been an upward trend in South Korea ever since national management was implemented in 2017.”
An antibiotic disrupts signal or metabolic process that are necessities for a bacteria to survive. Antibiotic-resisting bacteria avoids mechanism of antibiotics and remains as a dominant species in human body. Even if a new antibiotic is developed, it will not have any effect if it is based on same mechanism as previous medicines.
◊Unfavorable conditions left by antibiotic abuse
Super-bacteria is a global problem. WHO (World Health Organization) picked super-bacteria as the biggest negative factor that threatens mankind. Jim O’Neill, a British economist, estimated that about one million people would die annually until 2050 and that there would be $100 trillion of economic loss if antibiotic tolerance issue is not solved.
It is confirmed that up to $473 million (550 billion KRW) of social cost is spent in South Korea annually due to infection by super-bacteria. According to Choi Do-ja, who is a member of The National Assembly of the Republic of Korea’s Health and Welfare Committee, $122,000 (141.3 million KRW), $50,000 (58.07 million KRW), and $48,000 (56.21 billion KRW) of annual social costs are spent per CRE bacteremia patient, MRPA (Multidrug-Resistant Pseudomonas Aeruginosa) pneumonia patient, and MDRA (Multi Drug Resistant Acinetobacter Baumannii) pneumonia patient respectively. It is estimated that about 3,900 people die early annually due to super-bacteria.
People are becoming more anxious due to threats from new super-bacteria. Centers for Disease Control and Prevention recently warned about global spread of Candidaauris, which is based on fungus rather than bacteria and it is considered as ‘super bug’ as it is resistant to both antibiotics and anti-fungal drugs. Fatality rate is 60%.
“Candidaauris was found in the U.S. few years ago and it had caused tens of deaths.” said Professor Son Jang-wook of Korea University Medical Center’s Division of Infectious Diseases. “Although there is no report of Candidaauris in South Korea yet, it has high fatality rate and it is a matter of time before it is spread to our country.”
Biggest culprit is antibiotic abuse. Not only is antibiotic abuse rampant, but people tend to use stronger antibiotics if previous antibiotics are not effective. According to ‘statistics on amount of drug consumption and prescription drugs in 2017’, amount of antibiotics consumption in South Korea is 32.0DID. This means that 32 people out of 1,000 people take antibiotics daily. Meanwhile, average OECD is 19.6DID.
Infection management system is also poor. When South Korean Government announced its plans to manage tolerance of antibiotics in 2016, it required every medical office to report infections on CRE and VRSA. However, these reports are only limited to when they are found through culture tests. Because a culture test cannot be done on every critically ill patient unless patients are at large hospitals, it is difficult to take a preemptive action against these super-bacteria.
“Because more than 70% of patients who are infected by super-bacteria are infected inside of hospitals, infection management by hospitals is very important.” said Professor Uhm Joong-sik of Gachon University Gil Medical Center’s Division of Infectious Diseases. “Infectious disease monitoring system needs to be strengthened centered on intensive care unit.”
◊Need for development of infection monitoring system and medicine
People are generally infected by super-bacteria inside of intensive care units or laboratories as they are infected through various tools, blood, and saliva.
Nursing hospitals especially are seen as blind spots for infection. Because elder people are generally more likely to be infected by super-bacteria, nursing hospitals where there are many elder people are very vulnerable to super-bacteria. Excluding large hospitals where culture tests are done relatively frequently, nursing hospitals and small and medium hospitals that are financially less stable are more prone to super-bacteria infection. There needs to be more infrastructure support and infection monitoring systems for small and medium hospitals.
“Not only is medical charge on culture test for super-bacteria is limited, small and medium hospitals and nursing hospitals are very vulnerable to infection.” said Professor Son. “Although super-bacteria carriers need to be sent to nursing hospitals from large hospitals as financial resources can be wasted when they are admitted to large hospitals, it is difficult to do so at current level of nursing hospitals.”
There needs to be improvement in policies on medical fee and expansion of R&D when there is not any appropriate medicine for super-bacteria. There are only two to three super-bacteria medicines that are developed by multinational pharmaceutical companies. Not only are they expensive, but it is difficult to bring them into South Korea as health authorities appraise them at ridiculously low prices during negotiations.
South Korean medicines are also in a same situation. Although Donga-ST developed a medicine called ‘Sivextro’ in 2014, it gave up on selling Sivextro because its price was appraised at a ridiculously low price.
“It is not a business ethic to give up on selling a product in South Korea just because it has low profitability.” said a representative for a pharmaceutical company. “However, considering the fact that super-bacteria medicine is a medicine that is absolutely needed but does not have high demands, patients and pharmaceutical companies will be both happy if South Korean Governments appraises it at a reasonable price.”
Staff Reporter Jung, Yongcheol | jungyc@etnews.com