Greatest threat to health of humanity just decades away A grim outlook: Antibiotics could be rendered useless within a few decades, say disease experts. Infectious diseases experts are warning Australians could be living in a post-antibiotic world within a few decades unless urgent and co-ordinated action is taken to tackle escalating levels of antibiotic-resistant disease. Antibiotic resistance, caused by overuse of antibiotics in the health system and the agriculture industry, has been described by the World Health Organisation as the biggest threat to human health. "We're seeing more and more difficult-to-treat or impossible-to-treat bacteria," infectious diseases specialist at Melbourne's Austin Hospital Lindsay Grayson said. This ranges from the so-called super bugs to the very common bacteria, E. coli. What is fuelling concerns among specialists around the country is that increasingly otherwise healthy people are becoming infected in the community. "We believe there are some very alarming signs based on the patients we are seeing," Professor Grayson said. For example, three years ago we were seeing the super bugs only in immune-suppressed people; those with cancer, and transplant patients. Now healthy people in the community are getting very sick with super bugs, especially in their bowel and their urinary tract. The only thing these people had done was perhaps travelling overseas. Some had not even done that. Three recent patients in country Victoria hadn't been in hospital, hadn't travelled either and they had super-bug infections. He said we need answers to some fundamental questions. We need to know - but don't at present - two pretty basic things. How common are super bugs in the human and animal populations in Australia? And how prevalent is the use of antibiotics in these groups? Until we know the scale of the problem it's pretty hard to treat it. Last month, an outbreak of the potentially fatal super bug vancomycin resistant enterococcus, or VRE, in nurseries at Melbourne's Monash Medical Centre, and two of its other hospital sites, set alarm bells ringing. It was the first time VRE had infiltrated its nurseries. Director of infectious control at Monash Rhonda Stuart said screening revealed there were 38 cases where the bug had colonised in babies' guts but none of them had become ill. "Hospitals along the east coast of Australia are seeing more cases of VRE but we don't know why," Dr Stuart said. We routinely screen for it in our ICU and renal units, but now we will be including the nurseries, too. While it has long been understood antibiotic resistance in Australia has its origins in poor prescribing, the effect on Australia of other nations' antibiotic use has emerged as the other contributor. Travel, especially in Asia but also in South America, the Middle East, Greece and even certain boroughs in New York, poses a potentially huge risk if people become sick and wind up in hospital, Queensland University infectious disease specialist David Paterson said. "Australia will have its greatest issue through inter-hospital transfers," Professor Paterson said. We're seeing it with soldiers coming back from Afghanistan and Iraq and travellers coming from Thailand and Greece. Infectious disease expert at Australian National University Peter Collignon said the greatest risk posed by medical tourism was untreatable bacterial infections that kill. "We had a guy in the other day who had some plastic surgery in Asia and he picked up an untreatable bug, had a cardiac arrest and died," Professor Collignon said. He and Professor Grayson said Australia does not test for super bugs on imported foods but should. Antibiotic prescribing habits among doctors have for years been the main area for reform in the battle to combat resistant disease. A new study in the Medical Journal of Australia says more work needs to be done. The survey of Victorian hospitals found that in contrast to metropolitan public hospitals, most regional and rural public hospitals and the majority of private hospitals are not sufficiently funding antibiotic programs aimed at reducing inappropriate prescribing. Further, a lack of leadership and unwillingness by doctors to change prescribing practices were among the most common barriers to the success of these programs. One of the report's authors, Karin Thursky of Royal Melbourne Hospital, said the survey highlighted that the type of clinical expertise needed to oversee the use of antibiotics in hospitals was lacking and the problem was significant in rural areas and especially private hospitals. We know that half of the prescriptions being written are wrong and we have interns coming out of medical schools who don't have the most basic knowledge of prescribing. It's scary," Associate Professor Thursky said.