Since the middle of the 20th century, the use of antibiotics and the massive introduction of vaccination have considerably increased life expectancy, decreased infant mortality, and allowed invasive surgery and chemotherapy treatments.

That chain of success began back in 1928, when Alexander Fleming discovered penicillin, the antibiotic that transformed medicine. For a time, we had the feeling that thanks to these powerful new weapons, humanity’s fight against infections would finally come to an end.

However, expectations have not been met. We are still a long way from winning that battle. How is it possible? Very simple, due to the microbial resistance to antibiotics. That is, the ability of microorganisms to survive exposure to antibiotics that could normally kill them or stop their growth.

A major global public health problem

Every year 33,000 people die across Europe as a result of hospital infections caused by bacteria resistant to antibiotics. According to the latest data, 4,000 of these deaths are registered in Spain, four times more than those caused by traffic accidents.

Continuing with the numbers, antibiotic resistant bacteria are responsible for 700,000 deaths a year in the world. But they are also to blame for about 15.5% of hospital-acquired infections. There are even regions in the world where antibiotic-resistant bacteria are responsible for more than 75% of infections in hospitalized patients. Staggering numbers.

We are talking, therefore, of one of the greatest threats to global health and social development, capable of affecting anyone of any age and in any country. In fact, antimicrobial resistance is considered a major global public health problem.

And it does not seem that the situation is going to improve immediately. Estimates suggest that, unless global action is taken, antibiotic-resistant bacteria could cause an estimated 10 million deaths by 2050.

To make matters worse, bacteria resistant to antibiotics pose an extraordinary economic burden since, worldwide, they cost the health system around 1 billion euros per year. They even cause 3 trillion euros of loss of the Gross Domestic Product (GDP).

Although this phenomenon is a natural process observed in clinical practice since the first generation antibiotics began to be applied against microbial infections, the persistent use of antibiotics, self-medication and exposure to infections in hospitals have accelerated the development of multi-resistant bacteria.

ESKAPE bacteria

The problem of antimicrobial resistance (ADR) does not spread uniformly to all bacteria. The Infectious Diseases Society of America (IDSA) identified six species as especially dangerous, due to their virulence and potential multidrug resistance mechanisms. Grouped under the acronym “ESKAPE”, it is about Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.

This group of pathogenic bacteria seems to have a certain facility to “escape” from the bactericidal action of some antibiotics. In addition, the World Health Organization (WHO) has listed multi-resistant pathogenic bacteria in three priority groups:

Group 1: critical priority. Includes a Acinetobacter baumannii, Pseudomonas aeruginosa and some Enterobacteriaceae such as Klebsiella pneumonie, Escherichia coli. Also several species of the genera Serratia and Proteus. All of them are resistant to carbapenems.

Group 2: high priority. Includes a Enterococcus faecium (resistant to vancomycin), Staphylococcus aureus (resistant to methicillin and with intermediate sensitivity and resistance to vancomycin), Helicobacter pylori (resistant to clarithromycin), Campylobacter spp. (resistente a las fluoroquinolonas), Salmonella (resistant to fluoroquinolones) and Neisseria gonorrhoeae (resistant to cephalosporin and fluoroquinolones).

Group 3: medium priority. Includes a Streptococcus pneumoniae (no penicillin sensitivity), Haemophilus influenzae (resistant to ampicillin) and Shigella spp. (resistente a las fluoroquinolonas).

The solution is to use them wisely

On November 18 of each year, the European Day for the Prudent Use of Antibiotics is celebrated, a European public health initiative whose objective is to raise awareness about the threat posed to public health by antibiotic resistance and to promote the prudent use of antibiotics. the same. Both by the general public and among health workers and policy makers.

That day is part of the World Antimicrobial Awareness Week. That is to say, of antibiotics but also of antivirals, antifungals and antiprotozoals.

Since 2020, the slogan of the campaign is “Antimicrobials: handle with care”. The “Global Action Plan on Antimicrobial Resistance” has 5 strategic objectives:

• Improve knowledge and understanding of antimicrobial resistance,

• Strengthen surveillance and investigation,

• Reduce the incidence of infections,

• Optimize the use of antimicrobial drugs and, finally,

• Ensure sustainable investment in the fight against antimicrobial resistance.

Hitting the brakes on antibiotics

Antibiotic resistance is accelerated by the misuse and overuse of antibiotics, as well as poor prevention and control of infections. For this reason, the 2021 campaign of the National Antibiotic Resistance Plan (PRAN2021), launched within the framework of the World Awareness Week on the Use of Antibiotics and the European Day for the Prudent Use of Antibiotics, recovers the slogan “Antibiotics: take them seriously.”

Synthetic antibiotics

The discovery of new antibiotics is crucial to combat bacterial resistance. Recently, the group led by Andrew G. Myers of Harvard University has developed a platform to manufacture, from lincosamides, a wide range of new fully synthetic analog antibiotics. After testing the antimicrobial activity of more than 500 analogues, they found a promising compound, iboxamycin, an efficient compound against strains that are resistant to other known antibiotics.

Personal responsibility

We can individually adopt measures that help prevent and control the spread of antibiotic resistance.

These personal measures include using antibiotics only when prescribed by a certified healthcare professional, not requiring antibiotics if your doctor informs you that you do not need them, following the advice of healthcare professionals when using antibiotics, never sharing or using antibiotics. antibiotics left over from previous treatments, prevent infections by washing your hands regularly, preparing food in a hygienic way and keeping the vaccination schedule updated.

Raúl Rivas González, Professor of Microbiology, University of Salamanca

This article was originally published on The Conversation. Read the original.