Antibiotic resistance: the challenge of stopping our future leading cause of death

Antibiotic resistance (ADR) is one of the most pressing health concerns in recent years. Despite the fact that the coronavirus pandemic, a disease that being viral cannot be treated with antibiotics, has meant that all efforts in research, prevention and treatment have been directed to fight against SARS-CoV-2, the international medical community remains very concerned faced with the problem of bacteria and infectious agents becoming increasingly resistant to the antibiotic defense.

In fact, a recent study published in the prestigious 'The Lancet' assures that AMR claims at least 700,000 lives a year worldwide, a figure that is expected to increase to 10 million people when we reach 2050. In Europe, it currently causes around 33,000 deaths annually, 3,000 of which occur in Spain. Therefore, according to calculations by the Ministry of Health of our country, if urgent measures are not taken, it is estimated that by the middle of the 21st century it could become the leading cause of death ahead of cancer.

There has been "a significant increase in the use of antibiotics in hospitals and a notable decline in primary care during the pandemic."

At this point, one of the questions to ask yourself is if, in some way, the coronavirus pandemic has contributed to increasing or decreasing the problemto; either because the virus produces pneumonia with symptoms very similar to that caused by a bacterial infection and has been treated with antibiotics or, if on the contrary, consumption of this type of drug has decreased Due to the fact that face-to-face consultations in primary care were canceled during the harshest months of the pandemic and patients were unable to obtain these medications at the pharmacy as they needed a prescription from their GP.

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As recognized by the Ministry of Health, who has responded to a series of questions to this newspaper, there has been "a significant increase in the hospital environment and a notable decline in the community sector during March and April of last year." On the one hand, "the rise in hospitals responds to the diagnostic uncertainty at the beginning of the pandemic and the drop in primary care at the closure of health centers," they say Antonio López Navas and Cristina Muñoz Madero, coordinators of the National Plan against Antibiotic Resistance (PRAN) in the areas of Human Health and Animal Health.

"Although the level of consumption has already recovered the decreasing trend that had been observed in the pre-covid era, the specific increase in hospitals and the decrease in primary care could have consequences such as an increase in the risk of developing resistance in the case of hospitals or the reduction of the same risk at the community level, "explain the coordinators." Although covid-19 is a viral infection, and therefore, it is not treated or prevented with antibiotics, the diagnosis of coinfection or bacterial superinfection in these patients in many cases entails the prescription of antibiotic treatment ", recalling the recommendations addressed to health professionals to improve antibiotic prescription in the context of the pandemic, published in May.

A "bacterial pandemic"?

Now, what if we had to deal with a pandemic caused by bacteria instead of a virus in the future, counting on increasing resistance to antibiotics? Actually, "It is something that occurs on a small scale in most hospitals in the form of outbreaks", he asserts Jorge Anel, specialist in microbiology from the Puerta del Hierro University Hospital in Majadahonda, to El Confidencial.

"When there is resistance, higher doses than usual or synergistic combinations of several antibiotics are usually chosen"

This happens when "a bacterium that, being initially sensitive to many antibiotics (due to antibiotic pressure, much more common in the hospital environment), is capable of developing resistance to most or even all of them, and spread in a hospital ward or ICU, which can cause serious problems depending on the virulence of said bacteria ", explains Anel." In these cases, it is usually decided to administer higher doses than usual or by synergistic combinations of several antibiotics. "López Navas and Muñoz also corroborate this Madero: "In any case, superbugs are not a future risk, but an issue that is already part of our reality. We could define this phenomenon as a 'silent pandemic' with which we already live in hospitals. "

Is there going backwards?

Does this problem have a solution or have we already reached a point of no return? If we don't back down, we could reach a pre-antibiotic era, as the microbiologist explains. "The black plague, without going any further, was caused by the bacteria Yersinia pestis that wiped out more than a third of the population of Europe in the 14th century ", he says. For this reason, and in order not to return to these dark episodes of our past, research into next-generation antibiotics that are effective against super-resistant bacteria should be promoted, as well as continuing to raise awareness among the population so that you consume them wisely.

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"Self-medication has been and is, although now to a lesser extent, a very serious problem in Spain"acknowledges Anel." But the important The work of pharmacy offices has contributed to a considerable reduction in this bad habit. In the specific case of antibiotics, nowadays it is not possible to buy them without a prescription, and pharmacies make sure that this is done. "

More prepared and aware

One of the good news is that, in the event of a pandemic such as coronavirus but caused by bacteria, society would be more prepared and aware of prevention to fight an infectious disease. "This pandemic has meant a very important learning in the field of infection prevention measures", recognized by the PRAN coordinators. "Individual and group behaviors have improved because the collective awareness about the risk of contagion and the effects of the virus have increased very significantly in a short period of time. The challenge now is to strengthen collective awareness and translate it into attitudes that last over time. Only in this way can we effectively face future pandemics and threats that are already real, such as those posed by infections caused by multi-resistant bacteria. "

"Spain is currently in a tolerable situation, but we cannot be too careless"

Anel also believes that in case of reaching "the serious situation of suffering a pandemic caused by a multi-resistant bacteria (resistant to several types of antibiotics) or even pan-resistant (to all known antibiotics), the only thing left would be to increase the doses, always without exceeding the toxicity limit, or to use combinations of synergistic effect, until a new and effective antibiotic is available against the bacteria in question. "One of the particularities pointed out by the microbiologist of This hypothetical "bacterial pandemic" is that an infection caused by a bacterium will always need a drug to combat it, unlike a viral one, which in some cases can heal itself from the action of our immune system.

Currently, Spain has a strategic plan for resistance to antibiotics, the PRAN, launched since 2014 to monitor and control the consumption of these drugs, as well as to investigate new antibiotics and resistant bacteria. "This problem affects not only people, but also animals", emphasize the coordinates. "Within the European continent there are great differences between countries", concludes Anel, for his part. "In Northern Europe, especially in the Nordic countries, AMR is still not a very worrying problem. Something very different from what happens in some southern and eastern countries, such as Greece, Cyprus, Bulgaria, Romania or Italy, where resistance rates reach very high levels. Spain is, for the moment, in a tolerable situation, but we cannot be too careless ".