10 September 2020

Quarantine and isolation are terms that have affected many people since the coronavirus outbreak. People carrying a resistant bacterium, a bacterium that can no longer be treated with antibiotics, also have to deal with this. Although many people do not suffer from the bacteria themselves, they often have to keep their distance and are isolated in hospitals. Babette Rump researched what this means for these people. Thursday September 10th she will get her PhD at Radboudumc/Radboud University.

The research of Babette Rump, doctor Society + Health, infectious diseases and ethics, shows that the consequences for carriers of a resistant bacterium are large, because of the risk of infecting others. For vulnerable people it can be life-threatening. In nursing homes, for example, carriers are kept separate from other residents and excluded from social activities such as communal meals. Babette also came across other examples in her research: "A father who no longer dares to cuddle his child for fear of transmitting the resistance, a sister who does not go on a maternity visit, a mother who cannot give her daughter who has just given birth the physical closeness that both would like, and a child who cannot go to a medical nursery because of being a carrier.

Also isolation measures in hospitals

Resistant bacteria are especially a threat to seriously ill patients in hospitals and other vulnerable people. For this reason, care institutions are committed to keeping resistant bacteria out. People who turn out to be carriers of resistant bacteria in the hospital are therefore placed in isolation and cared for separately from other patients. In the care, the care personnel wear personal protective equipment such as mouth mask, apron and gloves. Wearers of drug-resistant bacteria are planned at the end of the consultation or surgical program, after which the room and equipment are intensively cleaned. Scheduled care is preferably postponed until someone has lost the resistant bacterium again.

Besides health also happiness and freedom

Most studies so far have looked at the consequences for carriers in terms of stress and other health aspects. In her dissertation Babette looks at the value people give to other things, such as happiness and freedom. She did this based on the Capability Approach model, by philosophers Martha Nussbaum and Amartya Sen. From this perspective it is about what carriers themselves find important in life and how this is put under pressure by measures. In this way it becomes clear that the impact of such measures on the lives of carriers is enormous.

Solidarity: joint responsibility for antibiotic resistance

Babette Rump concludes in her dissertation that a better balance needs to be found between isolating measures and the consequences for carriers. She explains: "We bear a joint responsibility for the problem of antibiotic resistance, but the problem now lies solely with the carriers. While we are causing the problem together. For example, failure to follow general hygiene measures or the incorrect use of antibiotics in healthcare are important factors that contribute to the formation of resistance. The use of antibiotics in animal husbandry, for example, also contributes to this, because it can be transmitted to humans". Because antibiotics are an essential part of healthcare - they are used in surgery, transplantation and chemotherapy, among other things - the burden of antibiotic resistance should not lie solely with the carriers.

Antibiotic resistance increasingly problematic

Isolating measures have been applied for years to people who are carriers of a resistant bacterium, a bacterium that is no longer sensitive to antibiotics. Since the discovery of antibiotics in 1928 by Alexander Fleming, antibiotics have played an increasing role in the medical world. Without good antibiotics, bacterial infections that are mild and harmless today could become life-threatening again. Meanwhile, more and more bacteria do not respond well to antibiotics, because they are widely used. The fact that bacteria become resistant is a natural fact, but was not a problem for a long time because new species were discovered all the time. In the meantime that does not happen anymore. This is a worrying problem, because in the future it will become increasingly difficult to fight 'simple' infections.

Promotion Babette Rump at the Radboudumc/Radboud University. Thursday September 10th. Title of the thesis: Caring for the Carrier - Responsible Care in Times of Antimicrobial Resistance. Supervisors: Prof. Dr. M.E.J.L. Hulscher, Prof. Dr. M.F. Verweij (Wageningen University) and Prof. Dr. A. Timen (RIVM/VU Amsterdam).

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