Opinion Piece: Claire Brandish
MRSA: Understanding a Journey from Farm to Pharmacy
I was working as an Antimicrobial Pharmacist in London and was struck by the story of a 6-month-old girl called Eveline, who was born with a heart defect in the Netherlands.
She was mysteriously found to be carrying a superbug, Methicillin-resistant Staphylococcus aureus (MRSA), which prevented her from having the much-needed surgery. Hospital epidemiologists traced the source of the MRSA back to the pigs on Eveline’s father’s farm.
The knowledge that antibiotic use on farms for livestock could lead to the spread of resistant organisms back to humans and threaten lives, sent shockwaves through the farming community.
This inspired a grassroots movement by farmers and vets to improve hygiene, reduce transmission of bacteria (between animals, the environment and humans) and reduce antimicrobial use on farms.
These techniques are now endorsed by the Dutch government and demonstrate the impact of this community as ambassadors for a one health approach to tackling antimicrobial resistance (AMR).
AMR is the natural emergence of microorganisms that can resist the effects of antimicrobial medicines and is a global issue. Indiscriminate use of antimicrobials in the human, animal and environmental sectors accelerates the problem yet we can all take responsibility to protect this life-saving resource.
As a pharmacist, this patient’s story reinforced the need to take a thorough patient history when considering infection so that the most likely organisms are considered.
This includes, but is not exclusive to, travel, occupation, pets, healthcare exposure, microbiology and sexual history. A decision can then be made as to what (if any) antimicrobials are appropriate when this information is used together with local treatment guidelines.
I have been amazed at the innovative work shared by the animal health, agriculture and food supply industries at the Antibiotic Guardian awards in the UK. The awards provide an opportunity to hear from all sectors involved with antimicrobials from around the world and to learn from each other.
I attended to share the work I have done at Buckinghamshire Healthcare NHS Trust (BHT) with our local schools to raise awareness of antimicrobial resistance and infection prevention through posters, comic strips, rap and dance competitions.
I was telling a vet that my cat needed antibiotics after she got a claw caught in one of her pads. My understanding was that this “prophylactic” single dose of antibiotic was reasonable as we recommend giving antibiotics in a similar way for contaminated wounds to patients at the hospital.
The vet explained that the antibiotic used would have had a very long half-life, meaning it was equivalent to giving a weeklong course of antibiotics and was probably unnecessary.
The lesson learnt for me was that prevention is better than cure and I made another pledge to protect antibiotics by cutting my cat’s claws!
In 2018, I became involved with a Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) project, funded by the Department of Health and Social Care’s Fleming Fund, between BHT, Nottingham Trent University and Makerere University in Uganda.
The goal was to raise awareness of AMR in Wakiso District, Uganda using a one health approach. A multi-disciplinary team of pharmacists, veterinarians, microbiologists, environmental experts, social scientists, lecturers and researchers in public health was formed to develop workshop material aimed at health practitioners and animal health workers.
We used an interactive approach focused on optimising antimicrobial use and infection prevention using the WHO and Ugandan National resources. We also considered how antimicrobials can be misused by patients, thereby increasing the risk of antimicrobial resistance emerging and spreading.
Examples included buying medicines from an unreliable source (counterfeit), not completing the course of antimicrobials, sharing them with family/friends, feeding them to animals and discarding them into the environment. We considered how to impact behaviour change and I was reminded of the powerful MRSA story of a Dutch farmer and his daughter, so we incorporated this into our training.
Health practitioners adopted a “train the trainer” model to engage Community Health Workers (CHWs) as the public frequently consult CHWs as a reliable source of information in African countries like Uganda.
We also visited schools and linked two primary schools in Uganda with two in Buckinghamshire to share competition videos and posters, highlighting similar messaging and encouraging others to become Antimicrobial Guardians.
I was fortunate to witness and be part of this CwPAMS programme to promote the responsible use of antimicrobials at the individual, health facility and National level using a multi-sectoral approach.
We have just received CwPAMS funding to extend this work and hopefully bring on board some community pharmacies to strengthen these messages for patients and the public.
At some point in our lives, we are all likely to need antimicrobials, be that to prevent or treat infection so I would encourage others to take a pledge to become an Antibiotic Guardian here.
Claire Brandish - Chief Pharmaceutical Officer's Global Health Fellow. Claire works as the Lead Anti-Infectives Pharmacist at Buckinghamshire Healthcare NHS Trust and has enjoyed working in the field of infectious diseases since 2007. Claire continues to collaborate with Nottingham Trent and Makerere Universities to Strengthen Antimicrobial Stewardship in Wakiso District, Uganda using a One-Health approach (CwPAMs). She is also the UK Lead Partner with Makerere University Hospital for a new CwPAMS project to establish a Sustainable centre of excellence for Integrated Antimicrobial Stewardship and Infection prevention and Control (SIAMS-IPC).
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