PETALING JAYA: Malaysia faces an uphill battle as infections may get harder to cure.
Some germs have gotten stronger, while a study at a hospital in Terengganu found that such bacteria can spread the ability to resist medicine to others.
Two types of bacteria have become stronger against antibiotics, the Health Ministry told The Star, but the increase in resistance was at “a slow rate”.
Such bacteria are Escherichia coli (E.coli), which causes wound and urinary tract infections, as well as Klebsiella pneumoniae (K. pneumoniae) which causes lower respiratory tract infection.
Both showed a spike in resistance rates, from about 25% in 2019 to 30% in 2023.
Other kinds of bacteria did not show much changes, but some recorded resistance rates as high as 92% to certain antibiotics, according to the ministry’s National Antibiotic Resistance Surveillance Report (NASR) 2023.
A study in a hospital in Terengganu, by local and international experts, showed that bacteria can also spread the ability to resist antibiotics to other types of bacteria, making the situation more challenging.
The good news is that Malaysia is taking steps to prevent this problem, known as antimicrobial resistance (AMR), from escalating.
The Health Ministry, through its National Antimicrobial Resistance Committee, is strengthening surveillance and promoting the appropriate use of antimicrobials in all sectors.
“The persistent threat of AMR is a significant concern in Malaysia and worldwide.
“The ministry is dedicated to combating this growing threat through a comprehensive One Health approach,” the ministry said.
Elaborating, it said AMR was a multifaceted issue, affecting human health, animals, agriculture and the environment.
“We are employing a collaborative approach that involves multiple sectors,” the ministry said, adding that such steps include careful application of antibiotics for human, animal, and environmental health, including at hospitals and clinics.
AMR is when infections become harder to treat because bacteria no longer respond to medicine.
It is caused by the overprescription of antibiotics to patients, as well as its overuse in food production, particularly in the poultry, livestock and aquaculture industries.
AMR is projected to cause about 87,000 lives to be lost between 2020 and 2030 in Malaysia if no intervention is taken.
Tougher to treat
It is difficult to pinpoint the reasons for the increase in resistance rates, but for some bacteria, it was due to the challenges in managing Covid-19 cases during the pandemic.
For example, the resistance rates for two bacteria, Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa), which can cause pneumonia and other infections, went up during the pandemic.
“The upsurge of the multidrug resistant A. baumannii and P. aeruginosa can be attributed to the complexity of managing Covid-19 cases.
"Some case management required multiple antibiotic therapy, leading to AMR development during the pandemic.
“But the resistance rates normalised in the recent years after the pandemic,” the ministry explained.
However, the resistance rate of E. coli continued to grow: its resistance rate towards the antibiotic Ciprofloxacin rose from 24.9% in 2019 to 30% in 2023.
Similarly for K. pneumoniae, the bacteria’s resistance rate towards the same antibiotic increased from 11.6% in 2019 to 19.9% in 2023, based on the NASR 2023.
Below is a look at the other bacteria covered in the report, and what diseases they can cause.
For the increasingly resistant K. pneumoniae, Universiti Malaya (UM) Centre for Natural Product and Drug Discovery microbiology unit assistant coordinator Dr. Jasmine E. Khairat described it as a significant threat.
Sharing her personal experience, she said her father had a scary health ordeal - after two weeks of coughing, he had a seizure and was admitted into the Intensive Care Unit.
“The culprit was identified as K.pneumoniae, and he ended up spending two weeks in the hospital,” she said.
Dr Jasmine said the level of antibiotic resistance varies among superbugs and across different regions and healthcare facilities within Malaysia.
“That is why continuous surveillance is crucial to monitor these trends,” she added.
On the multidrug-resistant P. aeruginosa, UM faculty of science institute of biological sciences senior lecturer Dr Muhamad Afiq Aziz said this bacteria was frequently found in hospital settings.
“It can cause a range of infections, involving skin, lungs and wounds.
“Its resistance to multiple classes of antibiotics makes treatment particularly challenging,” he said.
Because each bacteria can be treated with different antibiotics, they show different resistance rates depending on which medicine is used.
Here's a more detailed look at how each bacteria responded:
Worrying behaviour
Another challenge is that bacteria can spread the ability to resist the effects of antibiotics to other kinds of bacteria, potentially creating a bigger problem.
This was shown in a study conducted in a hospital in Terengganu by a group of researchers, led by Universiti Sultan Zainal Abidin’s Prof Dr Yeo Chew Chieng, whose expertise includes bacteriology as well as molecular and structural biology.
The team, made up of local researchers and experts from the United Kingdom, found that most of the A. baumannii bacteria were resistant to multiple antibiotics, based on 10 years’ worth of data.
Their research also found that 97% of the bacterial samples carried plasmids – tiny DNA ‘toolkits’ – that help spread antibiotic resistance.
“Some plasmids could be transferred to other species of bacteria and this complicates our fight against AMR,” said Prof Yeo in an interview.
Asked if this meant that more superbugs could be emerging in Malaysia, he said such a problem was not restricted to just our country but around the world.
“This is why the World Health Organisation (WHO) lists AMR as the top global public health threat,” said Prof Yeo, who is with the university’s faculty of medicine biomedical research centre.
A. baumannii, a well-known multidrug-resistant bacteria worldwide, can cause infections in blood, lungs, urinary tracts and wounds, typically in healthcare settings like hospitals.
What we can do now
Experts have urged for more to be done to stop AMR from getting out of control.
UM’s Dr Jasmine said while it’s good that Malaysia has action plans on AMR, it needs to be continuously tracked and evaluated.
“There should also be more surveillance by expanding systems across human, animal, and environmental sectors to track AMR trends and antibiotic usage which is crucial for informed policy and interventions,” she said.
Unfortunately, granular data for Malaysia is lacking when it comes to AMR, said Prof Yeo.
He said there was a need for better genomic surveillance, which is the process of monitoring pathogens and studying their genetic similarities and differences.
Likening it to knowing the various Covid-19 variants like Omicron and others, Prof Yeo said Malaysia needs such information on the various bacteria and their lineages so that there are clearer policies on which antibiotics to prescribe.
“If we don’t know the type of bacteria that are causing infections, it will be very difficult to counter this threat,” he said.
Prof Yeo said the time is now for Malaysia and the world to increase efforts in combating AMR, if we don’t want to face an "antibiotic apocalypse", a situation where bacterial infections are untreatable.
“The number of new antibiotics being developed and ready for use is coming in like a trickle, so we want to avoid it being outpaced by AMR,” he added.
Apart from being a hospital or clinical problem, Prof Yeo said our livestock are also being given antibiotics to prevent diseases and promote growth.
“This is indeed a very dangerous practice as many studies have shown that bacteria from livestock and animals could be reservoirs for not only potential bacterial pathogens but also AMR genes,” he said.
Dr Muhamad Afiq said the threat posed by AMR is comparable to major diseases like cancer and infectious diseases, considering its potential impact on global health.
He called on the government to invest in research and development of alternatives to antibiotics, such as bacteriophages (viruses that target and kill bacteria) and antivirulence agents, which work by disarming bacteria rather than killing them.
“These agents target factors like toxins and enzymes that make bacteria harmful.
“This search for antivirulence compounds is part of my ongoing research sponsored by the Higher Education Ministry, and we hope it can contribute meaningfully to the broader fight against AMR,” he said.
Calling for more prudent antibiotic use, Dr Muhamad Afiq said each time an antibiotic is used, an environment is created where only the bacteria that can withstand the drug survive.
“These survivors, often carrying resistance genes, then multiply and spread.
“This is what we call selective pressure.
“By using fewer antibiotics in general, we reduce this pressure, giving fewer bacteria the chance to develop and pass on resistance,” he said.
Every Malaysian also has a role to play in the fight against AMR.
Here’s how we can prevent AMR from spiralling out of control:
Never use leftover antibiotics or share
them with others. Don't self-medicate. You
might actually do more harm than you
intend.
Always complete the full course of
antibiotics.This ensures that all bacteria are
killed and reduces the risk of resistance.
