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- E. coli<\/i> (Escherichia coli)<\/li>\n
- Klebsiella pneumoniae<\/i><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
<\/i><\/i>These bacteria cause some of the most severe infections, which can progress to sepsis, organ failure, and patient death.<\/p>\n
First-line antibiotics (known as third-generation cephalosporins) for treating infections are becoming increasingly ineffective. These drugs are no longer working against more than 40% of E. coli<\/i> and more than 55% of K. pneumoniae<\/i>.<\/p>\n
Furthermore, reserve drugs are also at risk. Resistance is rising even to powerful antibiotics (such as carbapenems) that doctors use when first-choice treatments fail. This fact further narrows the choice of treatment options and makes fighting severe infections more difficult.<\/p>\n
MedScriptum recorded an interview with infectious disease specialist Inga Gvasalia, where we discussed the situation in Georgia against the backdrop of the alarming rise in antibiotic-resistant infections being recorded in hospitals worldwide.<\/p>\n
Interview with Infectious Disease Specialist Inga Gvasalia<\/strong><\/p>\n
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<\/p>\nThe WHO report reflects an alarming increase in resistance to Gram-negative bacteria, particularly E. coli and K. pneumoniae. In your practical experience, what are the most common and difficult-to-treat antibiotic-resistant bacteria you encounter in clinical settings today?<\/em><\/p>\n
The most common multidrug-resistant pathogen in Georgia is Klebsiella pneumoniae<\/i>, which is primarily recorded in intensive care units. E. coli<\/i> is also encountered, but its resistance rates in Georgia are not notably high. Based on current clinical observations, the frequency of Carbapenem-Resistant strains reaches approximately 60%.<\/p>\n
Based on your observations, which departments in the hospital environment (e.g., intensive care units, surgical blocks) record the highest rate of resistant infections, and what factors contribute to their spread?<\/em><\/p>\n
Primarily, the Intensive Care Unit (ICU) and the Surgical Department, where postoperative patients are located, stand out. However, the ICU remains in first place. Patients here are often undergoing several invasive procedures\u2014including the use of a central venous catheter or a urinary catheter. When a patient remains in the ICU for a long time with multiple invasive devices, hospital-acquired microorganisms are more frequently detected in those patients. A similar pattern is observed both in Georgia and globally: the concentration of multidrug-resistant hospital strains is always high in ICUs. Ultimately, invasive procedures and the prolonged stay of patients in these departments contribute to the spread of these infections, which makes proper patient care critically important.<\/p>\n
What trends have been observed regarding antibiotic resistance in Georgia over the last 5-10 years, and how does our country’s situation align with the global picture?<\/em><\/p>\n
The frequency of isolation of antibiotic-resistant microorganisms has significantly increased, both in Georgia and worldwide. In this context, the post-COVID period is particularly notable, during which the number of hospital microbes rose sharply. The intensified antibiotic therapy and the large number of hospitalized patients during the pandemic became contributing factors to the spread of resistant infections. Dynamically, over the past 5-10 years, there has been a sharp increase in both the number of such infections and microbial resistance.<\/p>\n
The resistance rate is increasing annually. In terms of prevalence, Gram-negative organisms take the first place. Gram-positive bacteria like Staphylococcus<\/i> rank second. Multidrug-resistant strains of Enterococcus<\/i> are also significantly widespread.<\/p>\n
The report notes that resistance is growing, even to powerful antibiotics. From your professional perspective, what strategic and practical steps should be taken nationwide to preserve the effectiveness of antibiotics and halt the deepening of this problem?<\/em><\/p>\n
Many steps need to be taken. Firstly, this concerns the rational prescription of antibiotics. It is known that antibiotic therapy is largely initiated outside the hospital, from the outpatient segment. There are frequent cases where antibiotics are prescribed for the wrong indication\u2014for example, for viral infections in children, which contributes to the increase in antibiotic resistance in adulthood.<\/p>\n
Also critically important is the regulation of antibiotic use in agriculture, for example, in poultry and apiculture (beekeeping). Specifically, the antibiotic colistin is often used in apiculture to maintain bee colonies. This is a negative trend because such products contain antibiotics and harm the resistance of microorganisms in the consumer’s body.<\/p>\n
Therefore, it is essential to systematize and control these processes. It should be noted that there is no unified, common database for resistance statistics in the country. At this stage, we can only rely on clinical observations, and infectious disease specialists have accumulated observations within specific clinics. The creation of a unified resistance database is of great importance. Accordingly, this process must be spearheaded by relevant institutions, such as the National Center for Disease Control and the Ministry of Health.<\/p>\n
This report shows that the problem of antibiotic resistance is particularly growing in low- and middle-income countries, where healthcare systems are consequently fragile. What specific systemic challenges contribute to such a rapid spread of AMR in developing countries, and what scale of strategies might be most effective in mitigating these risks?<\/em><\/p>\n
There are many challenges in this area, including financial issues. Specifically, the funding allocated per patient is insufficient, especially for those patients requiring long-term treatment in intensive care units. The deficit in financial resources further exacerbates the problem, as Georgia’s healthcare system is mainly represented by private clinics.<\/p>\n
Another significant problem is the insufficient number of mid-level medical personnel. There is a shortage of qualified nurses. An inadequate number of nurses directly leads to improper patient care.<\/p>\n
Furthermore, maintaining the quality of asepsis and antisepsis in clinics is critically important, and this is often not carried out at an appropriate level. As already mentioned, there is no systematization or systemic control of these processes. The country lacks a central database for studying hospital infections, which would ensure the collection of information about their number and degree of resistance.<\/p>\n
- Klebsiella pneumoniae<\/i><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
- E. coli<\/i> (Escherichia coli)<\/li>\n