There is an invisible threat that is keeping the planet in suspense. Alexander Fleming himself warned of this before it even became a reality, warning: “The time may come when everyone can buy penicillin online” in a prophetic speech eight decades ago after receiving the Nobel Prize in Medicine for the discovery of penicillin . Then there is the danger that the ignorant man will easily underdose and render his microbes resistant by exposing them to non-lethal amounts of the drug.” Fleming's omen has come true and today an epidemic of bacterial resistance is spreading worldwide, leaving a trace of Deaths from infections that were once curable with antibiotics.
Bacterial resistance is already killing around 1.2 million people worldwide, a number that experts predict will increase tenfold by 2050. “We are in a critical situation in which we need the cooperation of the whole of society to stop this pandemic: there is.” Patients to whom we give the latest generation of antibiotics die because these drugs do not work for them. And this will not slow down,” warns microbiologist Bruno González-Zorn, director of the Antimicrobial Resistance Unit at the Complutense University of Madrid and advisor to the World Health Organization (WHO) in this area. In Spain, a study of 130 hospitals found that these multi-resistant bacteria are already 20 times more likely to kill than car accidents: in 2023, more than 23,300 deaths were reported due to infections that did not respond to available antibiotics.
This superbug is increasingly attracting the attention – and concern – of all health authorities, but experts are calling for a strong change of direction to reverse the dire predictions in the short and medium term. “We are experiencing a globalization of antibiotic-resistant bacteria. They used to attack immunocompromised patients in hospitals and now they've made the leap into the community, with tuberculosis and drug-resistant sexually transmitted infections. “Multi-resistant bacteria have spread,” explains María del Mar Tomás, researcher at the Biomedical Research Institute of A Coruña and spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology.
The misuse or misuse of antibiotics, both in the health and veterinary sectors, is the reason for this health crisis, which is inexorably increasing in the face of other external factors that fuel resistance, such as the lack of new families of antibiotics that reinforce the therapeutic arsenal. . Climate change hasn't helped either, adds Tomás, because “it favors the persistence of these multi-resistant bacteria.” And although the Covid pandemic was caused by a virus, it has also led to an increase in the use of antibiotics in the hospital environment to respond to the secondary bacterial infections that often accompanied patients admitted due to coronavirus.
Bacteria are, in the words of González-Zorn, “valuable creatures with incredible adaptability.” But this means that they have the resources and weapons to mutate their genetic information in order to overcome adversity – such as antibiotics – and to colonize new ecosystems: They are able to reproduce with resistance, but also to pass it on to others passing on bacteria. No one is safe from these microbes, warns the scientist: “There are people who believe that they don’t have resistant bacteria if they don’t take antibiotics.” But we’re all in the same boat. The bacteria don’t stay in the person taking antibiotics, they affect all of us.”
On the other hand, globalization also helps to spread resistance. An example: A third of Spaniards who travel to India, where superbugs are widespread, usually bring multi-resistant strains with them as vectors. “They have no impact, but if they get an infection it becomes more difficult to treat them. And they can transmit these bacteria to their environment,” explains Jordi Vila, microbiologist and director of the Antimicrobial Resistance Initiative at the Barcelona Institute for Global Health (ISGlobal), a center supported by the “la Caixa” foundation. In any case, González-Zorn agrees that the key to establishing these multi-resistant bacteria in a country always depends on the local consumption of antibiotics: “A bacterium that is resistant to an antibiotic has a huge advantage if this drug is available.” Vicinity. When this antibiotic is not in the environment, sensitive bacteria also multiply.”
The WHO has been closely monitoring a handful of these microscopic enemies that are the most dangerous and for which new antibiotics are urgently needed. “The leader is still Acinetobacter baumannii. It is the primary problem and pan-resistant strains have been found,” explains Vila. There are bacteria with the ability to overcome all available antibiotics.
And these are not isolated cases, complains González-Zorn: “We are increasingly confronted with the fact that we cannot resort to antibiotics to cure patients.” In practice, this means that these patients no longer have any treatment alternatives available. “If the infection affects any part of the body, we resort to amputation to get rid of the infection. It sounds primitive, but it's what you do. In other cases, the patient is given medical support to try to strengthen their immune system as much as possible to fight the infection,” he says.
Faced with this terrible scenario, authorities and scientists have joined forces in the so-called One Health strategy, which consists of tackling the problem in different ways. “We have noticed that resistant bacteria are leaving the hospital and have found them, for example, in pets or in wastewater. “That’s why we have to fight them inside and outside the hospital,” explains González-Zorn. Countries have begun to reduce the use of antibiotics in veterinary settings and rationalize their use in healthcare settings to avoid new superbugs and, where possible, reverse existing resistance – some bacteria become sensitive again after the antibiotic has been out of use for a while Environment disappears. But there is still a long way to go. “Perhaps we will see a decline in the slope of rising resistances, although we will never be able to reach zero resistances. It will continue to increase gradually, perhaps at lower levels, but we need new antibiotics,” emphasizes Vila.
No new antibiotics are expected soon. Experts admit that the development of these drugs is not a lucrative market in the eyes of the pharmaceutical industry and suggest creating economic incentives to further increase their interest. In any case, they are also pursuing other research avenues to find new therapeutic tools. For example, phage therapy, which involves viruses that can destroy bacteria and has already been tested in some infections. “There are banks of natural phages that could be used to treat infections in combination with antibiotics. And if we don’t find natural phages, they could be genetically designed or synthetic phages could be created,” says Tomás, who studies these microbial cocktails.
However, prevention remains the key and González-Zorn assures that there is still room for improvement: “We treat ourselves more than the rest of Europe, 5% of pharmacies give out antibiotics without a prescription and we will have to prescribe them from 2024, not.” just to cure the patient, but to preserve the most modern antibiotics for when we really need them. “We need more commitment and awareness.” The evolution of this health crisis will depend to a large extent on whether all this improves worldwide, but everything is uncertain, the microbiologist admits: “It may happen that a pan-resistant bacterium spreads more easily and has higher mortality. but I don't think that will happen. . “I think this will continue to be a silent pandemic that will gradually progress.”
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