solution to killer superbug found in norway. new york times, december 30, 2009 oslo, norway (ap) --...

Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner. Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospitals of Europe, North America and Asia this year, soaring virtually unchecked. The reason: Norwegians stopped taking so many drugs. Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway's public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics. Dag Berild 2014

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Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009

OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner.

Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospitals of Europe, North America and Asia this year, soaring virtually unchecked.

The reason: Norwegians stopped taking so many drugs.Twenty-five years ago, Norwegians were also losing their lives to this

bacteria. But Norway's public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Dag Berild 2014

Page 2: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

However

• Bad things are happening in Scandinavia

Dag Berild 2014

Page 3: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Antibiotic use in eigth Norwegian hospitals (core units). Haug JB et al J Antimicrob Chemother 2011;66:2643-6.

Dag Berild 2014

Page 4: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

The threat• MRSA & untreatable S.aureus• ESBL-producing Gram.neg• Other multiresistent Gram.neg

• Acinetobacter/Pseudomonas

• Enterococci (VRE)• Penicillinresistent pneumococci• Resistant tuberculosis• Resistant tropical infections

Dag Berild 2014

Page 5: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Dag Berild 2014

Page 6: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Increased mortality in paediatric septicemia Tanzania casued by resistant bacteriae. Blomberg B et al J Clin Microbiol 2005;43:745-9

Dag Berild 2014

Page 7: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Is resistance a problem in industrialised countries?Steinmann J et al. Eur Surveill 2011;16 (33)19944

• Germany: Transplantation center; 7/5 pts. with ESBL-CARBA (New-Dehli bacterium) died

• Italy: 114/ 185 nursing home pts. with urinary catheters colonised with ESBL

Dag Berild 2014

Page 8: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Gonorrhea is not a serious disease, but…

Dag Berild 2014

Page 9: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Reduction of AB-resistant enterococci after the ban of Avoparcin

Dag Berild 2014

Page 10: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Antibiotic use in fish farming

Dag Berild 2014

Page 11: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Antibiotics in agriculture

• Animals: 70% prophylaxis– frequent use– low dosages– low hygiene– crowding– transportation

• 43 mill AB doses/day• Illegal use widespread

Dag Berild 2014

Page 12: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Antibiotic use in animals (NORM)

Dag Berild 2014

Page 13: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

Dag Berild 2014

Page 14: Solution to Killer Superbug Found in Norway. New York Times, December 30, 2009 OSLO, Norway (AP) -- Aker University Hospital is a dingy place to heal

We will face an apocalypse because of

• Political neglect• Ignorant, unethical and poor educated

doctors• Greed (false drugs, legalislation)• Agriculture, live stock, fruits• Lack of basic resources in dev. countries• Inadeqate infection control• No new antibiotics

Dag Berild 2014