Microbiology New Zealand Discussion 2022

Running head: MICROBIOLOGY
MICROBIOLOGY
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MICROBIOLOGY1
Introduction
Medications classified as antibiotics are currently used prevalently across the world, due
to their ability to effectively cure infections, illnesses and diseases caused due to microorganisms
like bacteria. Microorganisms which one were responsible to cause global epidemics can now be
safely controlled using these efficient medications (Frieri, Kumar & Boutin, 2017). However, a
key public health concern associated with the practice of antibiotic medication administration is
the emergence of microbial strains which are resistant to these drugs. Illnesses caused due to
microorganisms resistant to antibiotics is a concerning public health problem, which however,
can be prevented using effective stewardship practices related to hygiene and controlled
medication administration (Qiao et al., 2018).
Thus, with respect to the same, the following paper will provide and elaborate and
extensive insight into the emergence and transmission of Tuberculosis (TB) infections caused to
Mycobacterium tuberculosis strains which are resistant to antibiotics as well as the prevalence of
the same, coupled with the adherence to antibiotic intake practices within the New Zealand
context. Additionally, this paper will also provide key insights into the current impacts on society
and the risks in public health associated with infections spread by antibiotic resistant
microorganisms as well as existing or emerging guidelines which may prove to be beneficial in
combating this concerning health issue.
Discussion
Antibiotic Resistant Microorganism and Emergence
TB is an infectious disease caused as a result of droplet transmission, infected by the
bacterial strain Mycobacterium tuberculosis, and inhalation of the same across individuals. The

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main organs affected by TB are the lungs, though in certain cases the spine or the kidneys may
be affected as well. While this infection can be treated and cured, the concern rises when it is
caused by drug resistant bacterial strains (Dheda et al., 2017). Multi-drug resistant TB (MDRTB)
is a form of which demonstrates no response to treatment by two of the most powerful and
prevalent medication, namely rifampicin and isoniazid. Additionally, Extensively Drug Resistant
TB (RXDTB) is another rare form of TB resistant to antibiotics where the infection is not only
resistant to rifampicin and isoniazid but also any of the three second line of injectable
medications like kanamycin, amikacin or capreomycin and also a fluoroquinolone (Knight et al.,
2019). While their exist limited historical detail of the emergence of MDRTB is not known, the
first cases have been reported to have emerged during the years 1943 onwards, possibly due to
genetic mutations. Of this, TB strains classified as the ‘Beijing lineage’ – have been evidenced to
be a causative strain of MDRTB, due to its ability to adapt and mutate (Hargreaves et al., 2017).
Nevertheless, the key behaviors and factors which have been evidence to cause such mutations
and thus, resultant emergence of MDRTB, are associated with mismanaged or misuse or TB
drugs. Such malpractices include: lack of completion of a complete medication course during TB
treatment, administration of incorrect dosage and duration of medication intake by healthcare
professionals, inability of the patient to consume the required drugs due to unavailability and the
intake of anti-TB drugs which are of inadequate quality (Marks, Mase & Morris, 2017).
MDRTB and XDRTB are found prevalently in specific patient groups, such as those
individuals who engage in irregular TB medication consumption, who do not consume all the
required TB drugs, belong to regions with high rates of MDRTB and have been in contact with
patients diagnosed with TB (Trébucq et al., 2018).According to the World Health Organization
(WHO, 2020), there were approximately 4.1% or 8000 new reports and 19% or 600, 000 reports

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of MDRTB of previous cases. During 2017, these figures were reported to rise to an alarming
level in 2017, with new MDRTB cases rising to 558, 000 of which, 161, 000 were newly
detected and reported. Thus, such alarming rises in the prevalence of MDRTB infections can be
associated with a number of faulty medication practices as discussed previously (WHO, 2020).
New Zealand
The prevalence of TB and MDRTB in New Zealand (NZ) has been relatively low, with
the highest prevalence of 88.8% TB reported to occur in 2015. Of these however, approximately
96.2% of individuals in NZ reported with TB were treated on a timely manner and appropriately.
Of these, 34.5% of individuals commenced treatment within a month of symptoms whereas
37.3% reported to have engaged in TB treatment within 1 to 3 months of symptom onset.
However, only two or approximately 0.8% of these cases were reported to be infections of the
MDRTB type. Interestingly, both these incidences were of individuals born overseas of NZ thus
demonstrating the immigration from countries with high TB and MDRTB incidence as key risk
factors for MDRTB prevalence in the nation (New Zealand Government, 2019). Additionally,
since the last decade, approximately 1.2% cases of MDRTB were reported in the nation with an
alarming resistance to all forms of antimicrobials used for MDRTB treatment. Common
antimicrobials which are used for the purpose of TB treatment in NZ include Rifampicin,
Isoniazid, Streptomycin, Pyrazinamide and Ethambutol. Further findings demonstrate the
prevalence of MDRTB in cases with antimicrobials such as: 9% in Isoniazid, 8.7% in
Streptomycin, 4.5% in Pyrazinamide, 1.7% in Ethambutol and 1% in Rifampicin. While there
lies limited research concerning the origins of prevalence of MDRTB in NZ, some of the highest
cases were observed during the year 2003, where total number of MDRTB cases were reported
to be 376 cases respectively (New Zealand Government, 2019).