Antibiotic-resistant bacteria are scaring the planet. The number of deaths caused by this cause is already in the hundreds of thousands around the world – 1.2 million a year, according to one study – and the scientific community is accelerating the search for new tools to overcome the impact before it is too late is. Microbiologist Bruno González-Zorn, director of the Department of Antimicrobial Resistance at the Complutense University of Madrid and advisor to the World Health Organization (WHO) in this area, is optimistic at the forefront: after years of “preaching in the desert” alone and without much attention of the institutions, he managed to convince the actors involved and made progress, such as the implementation of a national plan to combat resistance or greater awareness among citizens, he says. “This makes me think that in the coming years we will make further progress, that there will be better prevention plans in hospitals, more awareness among the population, more optimized consumption and some preventive or therapeutic molecules that will help us more,” predicts the scientist , who visits EL PAÍS after participating a few days ago in the update conference on the antimicrobial use optimization program organized by the Mutua de Terrassa Hospital.
Despite the enthusiasm and hope, González-Zorn (Madrid, 52 years old) admits that there is still a lot to do and the pace needs to be accelerated. The researcher looks at no one and looks at everyone. Refuses to assign blame. “We are all responsible. The key is to work together without pointing fingers at each other,” he says.
More information
Questions. A study warns that multi-drug resistant bacteria are 20 times more likely to die in Spain than road accidents. More than 23,000 deaths in 2023.
Answer. We are starting to give a name and a voice to all the anonymous patients dying in hospitals from antibiotic resistance. There are constant deaths in all hospitals in Spain that no one talks about. And they die because the latest generation of antibiotics we give them no longer work. This problem is spectacular, we already know it. What we need is for the population to know that taking amoxicillin at home is not trivial [sin prescripción médica]: This prepares the bacteria to withstand the antibiotics of last resort that only hospitals have and which ultimately don’t work.
Q Are you surprised by the number of 23,000 deaths?
R. It doesn’t surprise us at all. We have known this topic very well for many years. What we like is that it leaves the purely scientific realm and that the population is aware that they cannot treat themselves, just like they put on a belt, and that they cannot keep an antibiotic if they do use at another time. We don’t need pharmacies that give antibiotics without a prescription, but in Spain it is still 5%. And while it may not seem like much to you, that 5% is doing a lot of damage to the other 95% because citizens realize that when they go from one pharmacy to another, they end up getting it without a prescription, and that trivializes that Antibiotic.
Q Is the antibiotic trivialized?
R. The antibiotic is trivialized in Spain. And in the end it has to do with the fact that, just like I have paracetamol, I have amoxicillin in my medicine cabinet and use it from time to time. That can’t be. We must take action against these 5% of pharmacies, against the person who self-medicates, against the professional who over-prescribes or according to the eighties…
We don’t need pharmacies that give antibiotics without a prescription, but in Spain it’s still 5%.”
Q Who suffers from this resistance? What is the patient profile?
R. It is important to know that even if you do not take antibiotics, the bacteria that live in hospitals, for example, and are more resistant to antibiotics, are the ones that affect you. You may be a young and wonderful person, but when you go to the hospital, you will be attacked by the bacteria that have been living in the intensive care unit (ICU) for a long time and are resistant to all antibiotics. The profile shows a person who arrives, for example, after an operation and whose postoperative infection, normal in all hospitals in the world, becomes so complicated that it ultimately leads to the patient’s death.
Q Is the era of antibiotics coming to an end?
R. We are beginning to enter a post-antibiotic era as mortality from diseases we previously controlled is increasing. We have more and more pan-resistant bacteria: previously we were talking about bacteria that are resistant to many antibiotics, and now we are talking about pan-resistant bacteria that are resistant to all antibiotics. Five years ago, these only existed in a few places in the world, such as India or China; There are now antibiotic-resistant bacteria in practically all Spanish hospitals. It’s progressing and we’re very worried. At some point we will have a bacterium that is very transmissible, that is very resistant to antibiotics, and then we will be alarmed. This will happen and we have been warning for a long time, so we need many people to take important treatment and prevention measures.
Q Can we see, for example, that you die from an injury sustained in a fall on the street?
R. We are already seeing it. We are already seeing urinary tract infections that are becoming more complicated and that previously responded well to antibiotic treatment, now patients are dying because they cannot be cured with antibiotics.
Q Has we reached a point of no return, or could taking action take us back to the antibiotic era?
R. The topic is complex. There are bacteria that, when no longer exposed to the antibiotic, become vulnerable very quickly and very easily. Therefore, in some cases the rollback is very quick and effective. For example: Colistin is an antibiotic of last resort in hospitals, widely used in animals, but in this context in Spain its use has decreased from a very high use to practically zero and the bacteria have immediately become sensitized to colistin. But there are also other resistances where it will be more difficult to regain this susceptibility: for example, with resistance to carbapenems or third-generation cephalosporins, we see that bacteria appear that are very happy with the resistance, even if the antibiotic is not present is .
Bruno González-Zorn, director of the Department of Antimicrobial Resistance of the Complutense University of Madrid, in a laboratory at the Faculty of Veterinary Medicine.Samuel Sánchez
Q In order to survive, bacteria will always try to continue resisting antibiotics. Is this a war for an indefinite period?
R. It is indefinite. Bacteria are the most common living organisms on earth. Antibiotics have done a lot of good, but effectively: If you stop developing new antibiotics – and we haven’t discovered a new family of antibiotics in 30 years – and only use these old weapons, bacteria become resistant. We need new families of antibiotics and as we develop them, we need new vaccines and new strategies to fight bacteria.
Q In a television program in which he took part during a trip to India, they managed to buy carbapanema, an antibiotic of last resort used when nothing else works, without a prescription at a pharmacy. What to do when this happens and we live in a globalized world?
R. We have to fight against it. Ultimately, resistance in each country depends on the antibiotics used in the country. It is not the case that everything comes from outside, everything colonizes our ecosystems and we are lost. National and local action is essential. The Dutch travel to India ten times more than we do and have far fewer of these bacteria. We have a direct link between antibiotic consumption in a country and resistance: even when they travel, bacteria colonize when the antibiotic is present, and when not, they lose their resistance.
Q What impact did the pandemic have on the fight against antimicrobial resistance?
R. In the short term it had a huge impact. Due to Covid, antibiotic-resistant bacteria have emerged that we did not expect to appear until 2030. Many respiratory viruses open the door to secondary bacterial infections and were initially treated with antibiotics, with Covid. But we quickly realized that Covid patients were not dying from a secondary bacterial infection, but from the famous cytokine storm, which is why patients began to be treated with corticosteroids instead of antibiotics. In the rest of the world, intensive care unit populations increased, these units became overwhelmed, hospital-acquired infections increased, and antibiotic consumption increased. The pandemic has greatly accelerated resistance to antibiotics, so much so that I say we will have the 10 million deaths expected in 2050 due to it in 2040 because of the emergence of bacteria resistant to it Antibiotics have increased enormously in the last resort.
Because of Covid, antibiotic-resistant bacteria have emerged that we didn’t expect until 2030.
Q Another variable that influences resistance is wars. There are now several active armed conflicts around us. How will this affect?
R. We know it affects us. Patients from Ukraine have already appeared with pan-resistant bacteria that did not exist in our region. Because? Because in conflict zones there is practically a perfect storm for the emergence of resistant bacteria: there is no system for diagnosing diseases, there are a large number of open wounds contaminated with many different types of bacteria. , broad-spectrum antibiotics are needed on a massive scale, where you don’t even have access to antibiotics and give everything you have… And this whole cocktail accelerates the formation of antibiotic-resistant bacteria exponentially.
Q To combat the phenomenon of resistance, they attack on multiple fronts. But he said there hasn’t been a new family of antibiotics in more than 30 years. Is the pharmaceutical industry not interested?
R. The economic model of antibiotic development is broken. There is currently no pharmaceutical industry in the world with more than 500 employees developing an antibiotic. They gave up on it because it wasn’t profitable. Lack of economic incentive. We are developing the pricing model that is now being discussed in the European Union: I give anyone who brings an antibiotic onto the market an economic prize, for example 300 million euros, which we have pooled together in all countries, because we need an antibiotic against these bacteria. Or we extend a patent for every molecule they have in their portfolio.
Q At the therapeutic level, one of the ongoing investigations is the use of bacteriophage viruses, phages, to destroy resistant bacteria. What are the most promising lines?
R. Phages have an exit, but you have 100 times more phages in your gut than bacteria and there are resistance mechanisms of bacteria to phages. So phages are one possibility, but there are many others. For example, nanotechnological techniques to allow molecules to sense where the infection is and release a more concentrated antibiotic. Artificial intelligence helps us a lot in knowing how an antibiotic behaves and how we can treat it individually. We could also develop bacteria that introduce [la técnica de edición genética] CRISPR, which ideally would be able to inoculate a CRISPR system into pathogenic bacteria so that their DNA is digested and they die. There are many very original strategies, many for gut health and prevention. For example, controlling intestinal health and probiotics and prebiotics: bacteria that colonize an ecosystem in which antibiotic-resistant bacteria cannot colonize.
You can follow EL PAÍS Health and well-being on Facebook, X and Instagram.