An image of carbapenem-resistant Enterobacterales, a type of bacteria resistant to one or several antibiotics called carbapenems. Photo: Supplied/ CDC
New technology has been designed as part of a project prompting doctors to prescribe more safely to help reduce the looming risk of antimicrobial resistance, which one professor describes as: "a silent pandemic that is occurring globally."
Bracing for an impending global antimicrobial resistance crisis, the health sector is developing New Zealand's first National Digital Antimicrobial Guidelines system.
Antimicrobial resistance occurs when pathogens mutate the ability to survive exposure to medicines like antibiotics, and is described as one of the top global public health threats in the 21st century by the World Health Organisation.
Healthcare professionals have partnered with New Zealand tech company RUSH Digital to develop the platform with the help of government project Te Niwha, which aims to ensure Aotearoa has world class research capability to respond to serious infectious disease threats.
The government was investing $36 million in Te Niwha, covering a three year period, from 1 September 2022 to 31 August 2025.
Among those working on the platform is infectious disease specialist Stephen Ritchie, a University of Auckland associate professor and chairman of Auckland City Hospital's Antimicrobial Stewardship Committee.
"We currently see patients with infections that are bacterial infections that are incredibly difficult to treat and it is a global crisis," Dr Ritchie said.
"It's a really horrible thing that's pervasive through all of healthcare. This affects cancer treatment, it affects safe surgery, it affects all aspects of medicine and it's already starting to limit what we do in some circumstances.
He said it is already happening in New Zealand's hospitals.
"There's huge implications for health care delivery, there's huge implications for cost, so the more resistance we encounter, the greater the length of stay that people have in hospitals. It just comes down to taxpayer costs."
Dr Ritchie said the aim is to unify New Zealand's 20 or so antibiotic guidelines for health practitioners, with there being a history of misappropriate prescribing of antibiotics in New Zealand.
"These guidelines vary in terms of quality and they vary in terms of being up to date or out of date, and what it amounts to is the treatments that doctors use or prescribers use to treat infections can be variable from one place to the next or one person to the next.
"For a long time, New Zealand has required a national kind of harmonised, agreed upon antibiotic guideline to sort of serve as a single point of where people get advice for prescribing," he said.
This issue around guidelines was a key finding in the 2021 Kotahitanga: Uniting Aotearoa against infectious disease and antimicrobial resistance report from the then chief science advisor to the prime minister, Dame Juliet Gerrard.
"What it means for people is that when they go to their doctor, their doctor now has hopefully a single kind of source to get advice, and we're hoping that leads to less variation in prescribing," Dr Ritchie said.
"Lots of studies have shown that if we prescribe, if the health care community prescribes according to guidelines - antibiotic guidelines that is - we get better outcomes, we get better outcomes for our patients, but also reduce costs, dollar costs primarily.
"The final thing we're hoping is that if we use a guideline that's well thought about, it might in the long term reduce the risk of antimicrobial resistance developing."
RUSH emerging technology manager Tim Packer said the role of technology in the Digital Antimicrobial Guidelines project is to amplify the voices of the infectious disease experts.
"I think that there's a great opportunity for technology to kind of amplify the voices of practitioners within the health system to reduce queues where administration overheads exist and to get the right care to the right people in a timely manner.
"So, there are quite a number of opportunities with current and emerging technology to do that."
Working with the health sector was not new for the New Zealand tech company, which started life as a video game developer about 15 years ago and built the Covid Tracer app.
Packer said that has helped lay the foundation for this project.
"That really opened up the possibility for rapid action through digital and how digital can really... prevent injuries and save people's lives.
"We open sourced the code on that (Covid Tracer app) and then helped other countries develop it, and it really put New Zealand in a leading position around Covid tracing and the use of technology to protect everyone," he said.
Playing a leading role against antimicrobial resistance in the Pacific is something New Zealand needs to embrace, University of Otago professor Dr James Ussher said.
Research in Samoa and Fiji demonstrated the existence of strains resistant to carbapenems - medicines considered a "golden bullet antibiotic", he said.
"There was some evidence from a genetic level that some of these isolates may have come from India originally, and there's strong connections between India and Fiji from a medical perspective," Ussher said.
"We're living in an interconnected world and... there's a large wave of resistance that is right on our doorstep that really... complicates the delivery of medicine.
"If these organisms are introduced into New Zealand it will spread within New Zealand, as we are seeing periodic patients with these organisms coming from the Pacific, it certainly complicates their management within a New Zealand setting as well.
"This is a silent pandemic that is occurring globally, and while New Zealand has been relatively immune to it for the moment, and that we've had very low rates of these sort of serious types of resistant bacteria, we're increasingly seeing cases introduced from overseas."
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