War spreads antibiotic resistance. "At some point, we will lose control"
Doctors and researchers say Ukrainian patients in Norwegian hospitals have served as a stark reminder of just how serious the situation is.
Kristian Tonby, senior consultant at Oslo University Hospital, has seen firsthand what might be coming.
Since the spring of 2022, he has been involved in receiving Ukrainian patients evacuated from hospitals in Ukraine.
Speaking at an event during Arendalsuka, he warned that ongoing wars are now spreading more antibiotic resistance. Arendalsuka is the largest political gathering in Norway and is held every August in Arendal.
Not an island apart
Norway still maintains relatively good control over antibiotic resistance, though the problem is growing here as well, says Brita Skodvin, head of the Norwegian Centre for Antibiotic Use in Hospitals.
She notes that countries like Greece and Italy, which Norwegians often travel to, have long had very high rates of resistance.
"But Norway isn't an island cut off from the world. We travel a lot and welcome many visitors," she says.
Hospitals are now also treating patients from war-torn countries such as Ukraine and Gaza. This brings new challenges.
Low risk of spread
When Ukrainian soldiers first arrived at Norwegian hospitals in the summer of 2022, healthcare workers were less prepared to handle this patient group.
"This has been a powerful reminder of the seriousness of the situation," says Tonby, who is also the head of the Norwegian Society of Infectious Diseases.
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Thanks to strict infection-control measures and routines, these patients have been managed effectively, he explains.
"The risk of these multi-resistant bacteria spreading in Norwegian hospitals is very small, but it's there," he says.
A major problem in Gaza
Norwegian hospitals have now received their first patients from Gaza.
"It's important that we accept patients who need medical help. Most people, including our politicians, fortunately believe that saying no is not an option," he says.
According to a study in The Lancet, which The Guardian has written about, multi-resistant bacteria now pose a major threat in Gaza.
"We know resistance is an issue in Gaza, and there's no reason to think the situation is any better than in Ukraine. On the contrary," says Tonby.
Shortage of infection control equipment
Tonby tells Science Norway about his experiences with severely injured war patients from Ukraine.
These patients first received life-saving treatment at Ukrainian hospitals after bomb explosions or gunshot wounds. There, they developed chronic infections.
"Severely injured patients are left in corridors where healthcare workers move from one to another without infection control equipment. This makes it easy for bacteria to spread," he says.
He explains that Ukrainian hospitals lack both diagnostic equipment and effective, targeted antibiotics.
Patients are often given broad-spectrum antibiotics. These are antibiotics that work on many types of bacteria instead of targeting one specific group.
Research shows that broad-spectrum use accelerates the development of antibiotic resistance. Once bacteria develop resistance, antibiotics are no longer effective.
"When resistance levels start to increase, they eventually reach a point where escalation is inevitable," says Tonby.
A hundred days in hospital
At Ullevål Hospital, they have treated patients who spent around 100 days in Ukrainian hospitals, enduring countless courses of broad-spectrum antibiotics with no improvement.
When these patients are evacuated from Ukraine to other hospitals in Europe, healthcare workers try to gain control using better diagnostics and more targeted antibiotic treatments.
This is challenging, according to Tonby.
"We've truly seen what it's like to treat patients carrying not only multi-resistant bacteria but also extremely resistant bacteria – and, in some cases, totally resistant bacteria," he says.
- Multi-resistant bacteria: Many types of antibiotics no longer work.
- Extremely resistant bacteria: Very few antibiotics still work.
- Totally resistant bacteria: No known antibiotics work.
Globally, 1.2 million people die each year from infections caused by antibiotic-resistant bacteria. Without intervention, projections show that by 2050, this could rise to 10 million deaths annually.
Kristian Tonby and colleague Arnfinn Sundsfjord have written about this in Dagens Medisin (link in Norwegian).
Rising concern in Norway
Sigurd Høye, head of the Antibiotic Centre for Primary Care, says public concern in Norway is growing.
"When we ask people in surveys what they associate with antibiotics and resistance, we see that many are more concerned about this than about climate issues or global instability," he says.
The main drivers of the problem are overuse, and misuse of antibiotics.
"More people now know that we shouldn't use antibiotics unnecessarily, but many still don't know exactly what actions they can take themselves. That's a challenge," says Høye.
Do not avoid necessary treatment
Kristian Tonby believes the average patient in Norway should not be so alarmed that they avoid a necessary course of antibiotics.
"It's important not to exaggerate the current situation in Norway. But we should be concerned about what may come. The ones who should be most alert are healthcare professionals and policymakers," he says.
He argues for system-level thinking and preparedness before the situation spirals:
"At some point, we will lose control, just as has happened in many European countries. If we wait until that happens, regaining control will be far harder."
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Translated by Alette Bjordal Gjellesvik
Read the Norwegian version of this article on forskning.no
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