Responsible care for amr carriers
In a joint ZonMW-funded project with RIVM (National Institute of Public Health and the Environment and RadboudMC we explore the ethical aspects of asymptomatic carriership of antibiotic resistance. The Netherlands are relatively successful in preventing outbreaks of antibiotic resistant microbes in hospital settings, thus limiting the mortality due to ABR. This success is at least partly due to high-level 'search and destroy' approaches, but those approaches can be very burdensome for persons who appear to be (asymptomatic) carrier of a resistant form of specific microbe.They may involve quarantine, contact isolation, social distancing, prolonged eradication treatment and postponement of for example surgery.
In her PhD study infectious diseases physician Babette Rump studies the impact of asymptomatic carriership and infection control measures on wellbeing of individuals, as well as the ethical problems. The key dilemma seems to involve a conflict between preventing outbreaks and transmission of ABR to patients who are vulnerable versus protecting quality of life of carriers. We argue however that this framing of the problem neglects that emerging antibiotic resistance is a much broader social phenomenon, for which society at large shares responsibility. Babette Rump and colleagues are developing an ethical framework for ABR prevention and control that builds upon an idea of social solidarity.