The so-called “superbugs” that we should be worried about are almost all Gram-negative bugs. This is where we have the shortage of antibiotics. We've run out of oral antibiotics in many cases, as I cited.
The high-priority bugs are generally food safety issues. If we have a good food safety process, you're not going to get salmonella. If you cook your chicken, even if it's drug-resistant salmonella, that drug-resistant salmonella doesn't care: it's dead. It's cooked. It's the same with campylobacter. If you're looking at staphylococcus aureus, a bug called MRSA, this is a problem and that can be community-acquired. However, the community-acquired variant is not as resistant as the hospital-acquired variant.
I want to point out one correction to a statement that was made by some of the prior speakers: not all people with drug resistance have a history of antibiotic exposure. MRSA is a perfect example of a drug-resistant pathogen that can occur in, say, children who have had no history of antibiotic exposure. That doesn't mean we shouldn't reduce antibiotic exposure overall, but it's not a situation of where there's smoke, there's fire—that just because someone has a drug-resistant bug, they've been exposed to antibiotics. There's not a straight line between the two.
What do we need to do? We definitely need much better lab surveillance. When I say “lab surveillance”, I think what we're doing right now is looking backward and saying that in the last two years we've had a problem. We don't have real-time surveillance to know where resistance rates are increasing. We have hospital labs that work in a silo separate from reference labs for each province. We have each province working in a silo separate from other provinces.
We need a very good, integrated lab information system for tracking the rates of resistance to drugs in bloodstream infections, urinary tract infections, ICU patients. We need to have that data at our fingertips so that we know what our rates are. Once we know what our rates are, then we know how much need we have for unusual antibiotics that are hard to come by, except through a special access program.
If new antibiotics are developed, we want to use them conservatively, so we need lab strategies whereby we can pick up this resistance quickly in a hospital lab near where the problem is so we can give very directed therapy. If we don't have lab tests at our fingertips, in the same places where we see the patients, we'll start shooting in the dark and giving everybody the broad-spectrum therapy because we don't want to be wrong. If we have precision testing for resistance markers, as I saw in Kuwait, for example—of course money grows on trees in Kuwait, but not here—if one has that type of access available, you can then be more specific and use the right antibiotic at the right time, which is a stewardship behaviour.
We do need to monitor our antibiotic consumption rates, especially in hospitals and even in long-term care. The theatre of war, as I said, is really in the hospital. That's where we have to be careful.
However, we're not going to end up at zero. I'll speak to a historic analogy, the Maginot Line. This is how the French thought they would keep the Germans out. They built this very elaborate defence system in the east of France, and the Germans came through the Ardennes and conquered France easily, so a huge investment made in one intervention is probably going to be wasteful.
I'm not saying antibiotic stewardship doesn't do a lot of great things; it does. It may reduce the duration of antibiotics that people get. It may reduce complications from having an intravenous when you could be on an oral antibiotic. It reduces costs. It may even help having infectious disease specialists like me seeing patients. Those are all great things, but does it reduce resistance? We don't know yet. It's one of many interventions.
If we put all our investment into this, we're making a mistake. If we don't do this and do all the other things, we're also making a mistake. Going back to my earlier slide, I think it's very important to have a combined strategy. I haven't spoken to the other veterinary strategies or food safety strategies that are important. Many other things have been spoken of, but I'll now speak to the patient care-related ones that matter the most here.
In terms of patient care, it's the real-time testing in acute care hospitals that matters. Right now, for lab testing in a hospital, the hospital must make a decision on whether to screen people for these World Health Organization priority pathogens. That's what we have to do now as an individual hospital. We have to decide if that's budgetworthy. We need a national strategy whereby money is available for this activity and we're not asking our hospital to choose to screen for one thing at the expense of another, essentially robbing Peter to pay Paul.
The final thing I want to speak to is this. Other than using antibiotics, there are biomarker strategies to reduce antibiotic use. Instead of just saying we should cut back on antibiotics, there are ways other than cultures, such as procalcitonin. We should be making very serious investments in this. It's used a lot in Europe and Asia to distinguish between infection and non-infection, because making this distinction is one of the biggest challenges in infectious diseases.
Then there are the global initiatives that I—