Researchers make a worrying observation: they have found infamous resistant germs in several Austrian bathing waters. How could the bacteria get there?
In several public and well-visited bathing waters, where children, senior citizens, families and resorts swim, they buy dangerous hospital germs against which almost no antibiotic is no longer helpful. This is not a concern for most people, but it is another step towards the "post-antibiotic age", which is feared by the World Health Organization (WHO), where we are almost powerless at the mercy of disease-causing bacteria.
Austrian experts have analyzed baths across the country for multidrug-resistant bacteria that are not suppressed by common antibiotics and are therefore difficult to treat. These are lakes, streams and peaty wetlands, frequented by many bathers and monitored by the authorities on a regular basis – but usually not at such microps that do not occur in nature.
The incident was caused by an incident in northern Germany, explains human physician Franz Allerberger of the Public Health Service of the Austrian Health and Safety Agency (AGES) in Vienna: a drunk man fell into a river and nearly drowned. He was rescued and taken to hospital. Here, however, he became ill with life-threatening sepsis, triggered by a highly resistant bacterial germ. These pathogens are common in hospitals today, despite strict hygiene measures, because you can hardly fight them. But it turned out that the patient had picked up the bacterium not in the hospital but in the river when it received water in the airways. The river water was therefore a source of contagion.
In four multi-drug resistant bath water
In Austria, AGES experts and their colleagues searched the country's bathing waters for such multidrug-resistant bacteria in the summer of 2017. Prostate samples were taken from each of the three official bathing waters in 27 countries of the 263 official bathing waters in the EU. The study will soon be published in the journal Bodenkultur. "We have been sampling water that is likely to find such germs," says Allerberger. The results therefore show the worst case scenario. Experts have found the multidrug-resistant bacteria in four bathing waters: in the Forchtenstein reservoir in Burgenland, in Ossiachersee in Bodensdorf in Carinthia, in Greifenstein, in the Danube Altar in Lower Austria, and in Bregenzer Wocherhafen in Vorarlberg.
Bacteria from Burgenland are bacteria of the Pseudomonas aeruginosa species, which have been feared since Roman times because they cause "green spider", a bluish-green manure infection, to weakened individuals. Today they are among the most common hospital calls. There were 51 resistance genes in the isolate from the reservoir, which allow bacteria to transport antibiotics from the cell, prevent them from being targeted and deactivated. Finally, the germ responded to several "backup antibiotics". These are antibiotics with serious side effects that should only be used in emergencies against resistant microbes.
In Carinthia and Lower Austria, these were Enterobacter intestinal bacteria, which, among other things, were immune to the synthetic antibiotic ampicillin-like penicillin and had up to 25 resistance genes. The germ of the earth was originally common, a very useful and well-known intestinal bacterium called Escherichia coli for humans, but here and there in the wrong way and can cause, for example, evil urinary tract infections. It was upgraded with 40 resistance genes and had the ability to cleave even the most advanced antibiotics using enzymes, rendering them ineffective. In severe infections with such pathogens, bathing water is knocked out in Lower Saxony, Bavaria, North Rhine-Westphalia, Baden-Württemberg and the only available single antibiotics available. And in Germany they went to the cause and the city of Hamburg because of the resistant microbes. In each case, multiresistant germs were found at multiple sites.
Weapons race between doctors and bacteria
Such pathogens have hitherto been known mainly from hospitals, where the arms race between doctors and bacteria takes place. Some use more modern, more modern antibiotics to remove germs, others collect resistance genes from their tribes and adapt them over and over to new weapons of medicine. Because the number of sites of attack on the bacterium and therefore the number of possible antibiotics is limited, researchers expect the bacteria to always emerge victorious from the duel.
In another study, published in January this year, AGES researchers explored rivers and discovered bacteria resistant to multiple drugs on the Danube near Linz and on the Glan in Carinthia. Upper Austria was a carbapenem-resistant Klebsiella bacterium. It can only be treated with an antibiotic called colistin, which has huge side effects, Allerberger reports: "In 43 percent of patients given this drug at high doses, kidney failure occurs." It is only used as a last resort.
Medical facilities are the source
The Carinthian bacterium was MRSA (methicillin-resistant Staphylococcus aureus), which has been causing problems since the 1960s. Researchers sequenced the genetic material of bacteria from rivers and compared it to the genome of hospital bacteria from patients. They identified a bacterium from the Danube using DNA imprints as almost identical to that of a patient from a hospital in Linz. The same resistant bacterium as from Glan was found in two patients at a clinic in Klagenfurt. So they were almost certainly on the wastewater of hospitals in nature, Allerberger says. This is not surprising, because in heavy rainfall, even with the best wastewater treatment plants, much of the wastewater would leak out into the rivers. Medical facilities and patients treated with antibiotics are thus the source from which resistant bacteria reach the lakes and rivers. By the way, they can also escape from the clear to the environment without heavy rainfall, Allerberger explains. In Germany, environmentalists have shown that water birds first swim in the pools of wastewater treatment plants, then fly up and down into natural waters. This way they can take away the bacteria.
Surprisingly, resistant microorganisms such as ESBL-enriched E. coli are also found in large numbers in young women and men, namely ten percent of pregnant women and seven to eight percent of Dutch recruits. "These are higher rates than for nursing home patients in intensive care units, where three to four percent are positive," says the doctor. Farming is responsible for this paradox: young people are likely to cancel resistant germs when handling raw meat. In England, for example, it has been found that high-performance chicken eggs are treated with a low dose of advanced cephalosporin antibiotics. They are responsible for the onset of ESBLs, which in turn ensure that cephalosporins are no longer effective in patients. These "elite hens" are almost the grandmothers and chickens that produce meat and eggs across Europe, often carrying resistant germs and spreading over large areas. "We were able to show that the chicks of this hybrid breed are 60 percent populated by ESBL," Allerberger reports.
Arms as the only way to reduce germs
Unlike MRSA, the usual strain probably comes from a pig farm. "However, MRSA germs in patients' blood cultures due to agriculture account for only eight percent, while the remaining 92 percent are from human medicine," he says. Livestock therefore contributes less to the problem than medicine to humans, and in recent years has reduced antibiotic consumption by one-third. This disarmament is practically the only way to reduce the number of resistant germs. Just as it is uneconomical for states to continually equip themselves with the latest weapons when there is no threat of attack, so it makes no sense for bacteria to conceal antibiotic resistance genes when difficult to use. In nature, multi-resistances disappear after a short or long time again.
This is also good news for swimmers. Although the pollution here and there is mostly from medical facilities, these are footage. A few days, weeks or months later, such germs should disappear unless renewed. The fact that this is no longer happening is primarily the task of the medical profession, which must get under control of the unnecessarily high consumption of antibiotics. It has not decreased slightly in recent years, although a third to half could be saved without worsening medical care, according to ECDC (European Center for Disease Prevention and Control). Up to half of antibiotics in clinics and in the private sector are medically unnecessary, up to 90 percent in long-term care facilities. In Austria, for example, antibiotic consumption during the flu season is always increasing rapidly. However, both real flu and flu are caused by viruses against which antibiotics are not effective. In this case, they do not promote human health, only the appearance of antibiotic resistance.
The world is aware of the problem. There is an international pact called the Transatlantic Antimicrobial Resistance Workforce (TATFAR), which also includes Austria. Here, the first task for individual countries would be to outline plans for how they want to reduce antibiotic consumption. However, out of 30 countries, only nine have done so, a TATFAR report shows. The remaining 21, Austria is one of these non-payers, unable to even think and document what measures could be put in place. In Austria, health insurance companies do not pay for quick tests that would immediately detect whether it was a viral or bacterial infection, Allerberger criticized. So if a doctor prescribes antibiotics to a patient, he or she will only pay the prescription fee while covering the entire cost of the test. To save long explanations and money for the patient, many registered physicians sometimes prescribe antibiotics slightly. A policy is needed here and it should better inform people about this problem. It would then be easier for doctors to fulfill another of the OECD's requirements for curbing antibiotic consumption: to wait for a prescription period before prescribing, and to wait a few days. For uneducated patients, such measures are much more contradictory than they are well aware of the problem.
But returning to Baden in Austrian lakes and streams: For healthy adults, children and adolescents, this is absolutely safe, explains Allerberger. Caution should be exercised with infants and the elderly over 70 years of age as their immune system is not as experienced or active. Risk groups include cancer patients undergoing chemotherapy and transplant patients who are less well protected from treatment and medication. It is important to evaluate on a case-by-case basis whether the positive effects of physical activity do not at all outweigh the small residual risk of infection with dangerous bacteria. After all, many more people in Germany die of cardiovascular disease than hospital-acquired bacteria. Swimming in chlorinated swimming pools is completely harmless. Patients can also take risks here, very young children and old people can cool down without risk.