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microorganisms that kill more than AIDS and malaria


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“There are very few cases, but we do have patients that we cannot treat in any way,” says Roi Piñeiro, head of the Villalba Hospital Pediatric Service and member of the Medicines Committee of the Spanish Pediatric Association. “If your body doesn’t get over it, we can’t help you with any medicine from the outside.”

Bacteria, viruses, fungi and parasites naturally develop mechanisms of resistance to the action of drugs, but the abuse and misuse of antimicrobial that combat them is accelerating the appearance of strains that are increasingly difficult to eliminate.

“He has this infection, if his body does not overcome it, we cannot help him with any medication” Roi Piñeiro, head of Pediatrics at Villalba General Hospital

“In Africa there is tuberculosis that is extremely resistant, we cannot risk that patient infecting another person. We have to confine them guarded by the army so they don’t come out. And this that seems like science fiction, luckily there are few cases, but it happens today, “warns Piñeiro.

In infections caused by bacteria, the battle is over the efficacy of antibiotics. They are popularly known as ‘superbugs’ when they are capable of resisting the action of several of them.
According to a study published in The Lancet
1.27 million people died from this cause in 2019. Most of them from infections acquired in hospitals.

María Jesús Lamas, director of the Spanish Agency for Medicines and Health Products, warns about the indifference with which we assimilate the phenomenon: «This supposes a major public health threat. Although we have to be careful in how we convey this because, after two years of the Covid-19 pandemic, with such a dramatic number of deaths and so much information, we have become somewhat desensitized to what a public health threat is. . But this really is, there is data that already confirms it: in Spain, more than 4,000 people died last year from multi-resistant infections and more than ¾ of them have been acquired in the hospital due to another process, that is, they were not admitted with the infection”.

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“We have become somewhat desensitized to what a public health threat is. But this really is it» María Jesús Lamas, director of AEMPS

For Patricia Bernal, resistance to antibiotics by pathogenic microorganisms represents a true silent pandemic. This microbiologist from the University of Seville has worked on a
Imperial College London study
led by the researcher Despoina Mavridou, with encouraging results: the confirmed idea is that it is possible to get superbugs become vulnerable to drugs again that we already know. Inhibiting the DsbA protein, whose function is to fold other proteins, destroys the pathogen’s armor: “When proteins do not fold, they degrade and many of them are responsible for antibiotic resistance. If we inhibit this protein, we are indirectly inhibiting antibiotic resistance.”

On the left, a super-resistant bacterium survives the action of the antibiotic.  On the right, the bacterium dies after using an inhibitor of the DsbA protein and the antibiotic Imipenem, as shown in the study by Dr. Mavridou
On the left, a super-resistant bacterium survives the action of the antibiotic. On the right, the bacterium dies after using an inhibitor of the DsbA protein and the antibiotic Imipenem, as shown in the study by Dr. Mavridou – Photo: Nikol Kadeřábková

Although the conclusions of the study are very positive, it is still a proof of concept. In Bernal’s words, we are still at the starting point, very far from its application in hospitals. “The study used an inhibitor that is highly toxic in humansRight now, Dr. Mavridou’s lab is studying new inhibitors that can be used in clinical trials. We are at step one.”

The constant search for drugs capable of attacking multiresistant bacteria is, in the opinion of experts and Bernal herself, a very limited approach: «Discovering new antibiotics is getting harder, requires a lot of investment and resistance arises very quickly, you have to look for the more alternatives, the better». In addition, Lamas confirms the growing disinterest of the private sector: «These are drugs that we are going to ask the industry to develop so that they are not sold later. Because what we want is for them to be used as little as possible.”

This study poses not only an obvious economic advantage, but also an efficiency one, since the technique would be effective in the most frequent multiresistant infections, those that are acquired in the hospital setting, which belong to the so-called ESKAPE group (acronym for the six resistant bacterial pathogens most common antibiotics in healthcare settings).

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millions of deaths

By 2050, if we do nothing, it is estimated that
10 million people could die from this cause
, as many as deaths from cancer in 2019. To the loss of human and animal life, we must add the economic consequences of a phenomenon that would lead 24 million people to extreme poverty. But since 2014, in response to the European Union’s wake-up call, several countries have been developing national plans to combat antimicrobial resistance. In Spain, the National Plan against Antibiotic Resistance (PRAN) has achieved remarkable results in terms of the decrease in the consumption and sale of antibiotics.

According to data from the PRAN, Spain has already abandoned the top positions in terms of antibiotic consumption in the EU.

The improvement in prescriptions, the awareness of the population and prevention have had very positive results at a quantitative level; According to data from the PRAN, Spain has already abandoned the top positions in the EU, with
a decrease in consumption of 32.4% in human health and 56.7% in animal health
.

For Lamas, “in this sense it is successful. What remains to be seen is whether it has had any impact on the appearance of resistances or not.
According to the latest OECD report on resistance surveillance
, in northern Europe, the decrease in consumption has been accompanied by a decrease in the appearance of resistance. If this can be verified, we can say that we have been successful, if not, what we can say is that we are on the right track”.

Guerrilla warfare

However, although the figures are encouraging, the fight against antimicrobial resistance is complex. No new types of antibiotics have been discovered for years despite financial support from the EU; therefore, it becomes more important to have a diversified strategy.

The PROA teams (Antimicrobial Use Optimization Programs), made up of microbiologists, infectologists and pharmacists, are one of the fundamental spearheads to stop the appearance of resistance. They analyze all the information available in detail, taking into account the usual flora of the hospital where they work, the resistance pattern of a specific pathogenic bacterium and the antibiotic that best fits, in the minimum effective period.

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“The PROAs are a necessary investment in health centers. They were born almost spontaneously, by the will of health professionals who saw the need. It is still difficult to find resources in the hospitals assigned to the PROAs. I believe that these are the duties that remain for us to do. They must be included in the portfolio of hospital services and of health centers as other basic services, ”claims the director of the AEMPS.

hypermedicalized culture

Neither the prevention teams, nor the investment, nor the development of new antibiotics can be effective if there is not a change in the culture of drug taking.

Piñeiro calls for responsible use from both sides; by health professionals, prescribing antibiotics only when there is evidence or high suspicion of bacterial infection and by patients, complying with treatment times and guidelines:

“A one-year-old boy diagnosed with acute otitis media. At that age, it is recommended to use an antibiotic called Amoxicillin, in high doses, every eight hours, for a week. What happens if we don’t make it that week? For example, he takes it for three days, he is already well and we stop taking it: high risk of recurrence.

In the opposite case, if the recommended time is exceeded, what happens is that other neighboring bacteria are exposed to the antibiotic and, with that information, begin to develop resistance mechanisms. Pathogens can learn to defend themselves against our weapons.

“There is still a lot of education needed for families so that they understand that many processes are natural and are defense mechanisms of the body, including the fever, the blissful cough and the blissful snot. are all necessary, we can do something to alleviate these symptoms, but it is not correct to eliminate them completely because we are removing the possibility that our body defends itself. We come from a hypermedicalized culture. Not everything has to be treated or removed. Many times you have to wait to see how it evolves.

Lastly, he makes a request to the parents that he knows they will not like: «Don’t press for curative medicine because, very often, particularly in pediatrics, there is none. 95% of the infections that children have are viral and, for viruses, antibiotics do not help».

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