I am back on the road filming the seventh series of RTÉ’s 10 Things to Know About (coming to your screens in November) and a story about water quality brought me to Salthill.
It was one of those hot, calm days when it’s hard to tell when the blue sky ends and the blue sea begins.
Unfortunately, the beautiful seascape of Galway Bay took on a different perspective as I interviewed NUI Galway researchers about their water quality studies which have identified the presence of antibiotic resistant bacteria in Irish bathing waters. The thought that the waters lapping at my ankles may be polluted with untreatable superbugs took the sheen off the glistening sea.
‘Blue spaces’ is the term given to places where people swim recreationally and in Ireland we monitor the water quality of these spaces during the bathing season, from June 1 to September 15, for the presence of E coli and intestinal enterococci (IE).
Irish beaches, generally, rate highly in terms of water quality but what is being monitored is quite small, just two microbiological parameters, and for a short period - 18 weeks. Considering that many hard core sea swimmers take the plunge throughout the year, this limited testing period is possibly missing out on a bigger picture.
You may have heard of superbugs like MRSA or antimicrobial resistant bacteria (AMR) in relation to hospital settings, but AMRs can be found in our waters and scientists are only beginning to understand and work out how they get there and the effect of their presence on humans health and the wider environment.
Antibiotics are medicines used to prevent and treat bacterial infections. Antibiotic resistance occurs when bacteria change in response to the use of these medicines. Our over-use of antibiotics to treat humans and animals means that bacteria is exposed to these medicines regularly and can evolve protection mechanisms - and become resistant.
If a person or animal becomes infected with a resistant strain, some antibiotics will no longer be effective against the particular type of bacteria.
The World Health Organisation (WHO) considers antibiotic resistance “one of the biggest threats to global health, food security, and development today” saying the “misuse of antibiotics in humans and animals is accelerating the process and a growing number of infections - such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis - are becoming harder to treat as the antibiotics used to treat them become less effective.”
The WHO warns that “antibiotic resistance is putting the achievements of modern medicine at risk. Organ transplantations, chemotherapy and surgeries such as caesarean sections become much more dangerous without effective antibiotics for the prevention and treatment of infections. Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill”.
Which is why it’s very concerning that Irish scientists have found resistant bacteria like Carbapenemase-producing Enterobacteriaceae (CPE) in their samples of Irish water.
Treatment of infection with CPE is very difficult as they are resistant to almost all available antibiotics. In 2017, the National Public Health Emergency team (NPHET) declared a public health emergency in relation to CPE.
How does something like CPE end up in our water and wider environment? Most likely through untreated sewage entering the sea or from untreated animal waste that has been spread as fertilisers on fields in the vicinity of recreational bathing areas.
To play our part in preventing and controlling the spread of antibiotic resistance, individuals should only use antibiotics when prescribed by a doctor, finish the course of treatment and bring any leftover medicine back to the chemist for safe disposal.
This is particularly relevant with children’s liquid formulations of antibiotics that are often unthinkingly tipped down the sink or toilet - it all ends up in the sea!
The agricultural sector, where antibiotics can be used indiscriminately to help promote growth and preemptively prevent infections, needs to change too. These antibiotics are excreted in animal faeces, many of which are spread on land as a fertiliser and then are washed off into our streams and rivers as agricultural run-off, ending up in our coastal waters.
All this information is not intended to make us nervous or queasy about swimming in the sea or deter you from a daily dip. The benefits to our health and wellbeing of wild swimming will, most likely, outweigh the small risk of being colonised by an AMR and we are fortunate in Cork with lots of clean, Blue Flag beaches.
However, this knowledge should make us think about our position in the interconnected natural environment and how all our actions have consequences.
If we want antibiotics to remain the most powerful tools in our arsenal for treating infections and disease, then we must treat them with the respect they deserve.