Curbing resistance

Why does work on antibiotic resistance matter?

What’s MSF’s strategy to tackle antibiotic resistance?

We have three pillars we believe play the most important roles in curbing resistance: increasing diagnostic capacity, improving infection prevention and control (IPC) in our facilities, and promoting the rational use of antibiotics so people only get the antibiotics they truly need when and for the length of time they need them. In our projects, we have microbiologists and infectious disease specialists, we have staff members responsible for hygiene and infection control, we have pharmacists who supervise access to antibiotics—and then, of course, we have the management team who is also involved in making sure we don’t lose sight of these pillars. 

Why is tackling resistance a priority for MSF?

MSF’s focus on ABR began in the Middle East when we started receiving war-wounded patients with open fractures that were more susceptible to infections like osteomyelitis, a bone infection. From the first day—the first patient—we had to face this problem, because the bacteria we were dealing with were highly resistant to many drugs. This was partly because of the overuse of over-the-counter antibiotics in places like Jordan, Iraq, and Yemen.

We started asking ourselves, “Why is the patient I am treating with antibiotics not responding? Maybe there is [drug] resistance?” Curbing resistance is also important where patients are malnourished, have higher rates of severe burns, or have malaria or HIV, since when you are immunosuppressed you have a higher risk of getting an infection and needing antibiotics.

What are the biggest challenges fighting ABR in low-resource settings?

If clinicians see that their patients are not responding— and they don’t have tools to diagnose the exact infection and identify which antibiotic would be most effective— their temptation is to switch to a more powerful antibiotic. While doctors may think that’s the best or only option to save the person in front of them, we want to avoid this kind of blind prescription of antibiotics because it can lead to more resistance.

Then you have the problem of hygiene and infection control in health facilities. We have to train staff to enforce IPC measures, like properly washing their hands between patients. Staff also need to know how to implement a proper isolation area for patients with drug-resistant infections. You need to know that patients infected with the resistant bacteria are isolated and that those bacteria are not going to spread across the hospitals. This is, to be honest, one of our biggest challenges—more than the diagnostic challenges and more than the rational use of antibiotics.

How can MSF make an impact when this is such a complex, multidisciplinary, global problem?

It is true that it is not enough to have only MSF working to curb resistance. I think that at the level of our hospitals we can only have an impact on the direct clinical management of our patients. But that’s why one of our advocacy strategies is to share our experience with other actors in order to have more and more people and organizations involved in this.

We are large and, in some areas, we are the only actor that has the ability to adhere to those three all-important pillars [to tackle ABR] in the same facility and show that this model works. Another way MSF has an impact is resistance surveillance. In Mali, for example, we worked to have our microbiology lab recognized as a surveillance laboratory to monitor resistance in the region. I think MSF can have a huge impact if our work can help shape and reinforce national surveillance systems.