An Indian university student sick with tuberculosis, a Kenyan veterinarian hospitalized for months with an infection after surgery, an American gymnast infected with staphylococcus, or a baby in Indonesia with respiratory problems, vomiting and diarrhea: all have suffered the “silent pandemic.” , as the World Health Organization (WHO) describes antibiotic-resistant bacteria. These are present in almost five million annual deaths (that is, those affected had an infection, even if another cause of death was recorded), and they are the direct cause of 1.27 million of them. Sub-Saharan Africa and South Asia are the two regions with the highest incidence of deaths attributed to antibiotic resistance, with more than 20 per 100,000 inhabitants, compared to 13 on average in developed countries.
Some 750,000 deaths associated with superbugs could be avoided each year, especially in low- and middle-income countries, by improving measures such as hand washing and disinfection in healthcare environments, access to clean water or the extension of childhood vaccines. It is one of the conclusions of a series of four articles published in the scientific journal The Lancet this Thursday (early morning on Friday in mainland Spain) on “sustainable access to effective antibiotics.” The authors, 38 experts in antimicrobial resistance and global health from around the world, warn that it is a growing problem that will cause more and more deaths if it is not tackled — a 2016 study estimated that by 2050 it would cause 10 million deaths per year —, and that especially affects the most vulnerable groups.
“The small pool of effective antibiotics has been reduced, especially in resource-poor settings, and the very young, very old, and severely ill people are especially susceptible to resistant infections,” states the first of the four texts, which focuses on the global scope of the problem and how to measure it. Antibiotic-resistant bacteria “pose a major obstacle to achieving the Sustainable Development Goals, including the goals of neonatal survival, progress in healthy aging and poverty alleviation,” he continues.
Without action, more people will become infected and die from resistant infections, and treatments will become more expensive and potentially inaccessible to people in the most resource-limited settings.
Iruka Okeke, professor of pharmaceutical microbiology at the University of Ibadan, Nigeria
One of the co-authors, Iruka Okeke, professor of pharmaceutical microbiology at the University of Ibadan in Nigeria, describes by email the scenario if action is not taken now: “More people will become infected and die from resistant infections. Resistance to last resort drugs could be more than twice as common in 2035 as in 2005. Treatments will be more expensive and potentially inaccessible to people in the most resource-limited settings.”
These environments, which in turn have a higher incidence of infectious diseases and lower capacity in their health systems, are precisely “those that can benefit the most from the containment of antimicrobial resistance” through existing tools, explains Okeke. Thus, in low- and middle-income countries (or developing countries), 337,000 deaths per year associated with resistant bacteria acquired in health centers – one of the most frequent forms of infection – could be avoided, compared to 1.7 million deaths a year today, improving the prevention and control of infections in them.
These interventions include increased adherence to hygiene standards, primarily handwashing by healthcare workers, and improvements in environmental cleaning, antiseptic techniques, and disinfection and sterilization measures, to prevent infections through central or intravenous lines. peripheral devices, catheters or ventilators, and surgery. To achieve this reduction in deaths, the prevention and control standards of these countries would have to be aligned with those of high-income countries, according to the mathematical model developed by the authors, addressed in the second article in the series.
Guarantee universal access to water, sanitation and hygiene services, which would prevent 247,800 deaths associated with antimicrobial resistance
The study also estimates how many deaths would be avoided in these countries by preventing infectious diseases in communities and reducing the use of antibiotics to combat them. One of the methods is to guarantee universal access to water, sanitation and hygiene services, which would prevent 247,800 deaths associated with antimicrobial resistance, although the article warns that to reach this figure, higher quality interventions are required than those proposed. at the moment.
The other tool is to achieve universal coverage of pediatric vaccines, which would prevent 181,500 deaths, both by direct prevention of resistant infections and by reducing antibiotic consumption, according to the analysis.
Triple objective
Okeke considers that these interventions, which would reduce the incidence of deaths associated with resistant bacteria in developing countries by 18%, “are realistic, even in environments with limited resources.” The authors of the series aspire to a triple objective at a global level in 2030, set out in the fourth of the articles: reduce antimicrobial resistance by 10%, reduce the inappropriate use of antibiotics in humans by 20%, and the inappropriate use in animals by 30%. To this end, they call for prioritizing the actions proposed at the UN General Assembly that will take place in September.
“Our findings indicate that reducing the global incidence of antimicrobial resistance by 10% by 2030 is achievable with existing interventions. Our results should guide investments in public health interventions toward those with the greatest potential to reduce it,” the text says.
However, these actions are not enough to ensure that everyone who needs it can access affordable and effective medicines. “The growing number of bacterial infections worldwide that do not respond to available antibiotics indicates the need to invest in – and ensure access to – new antibiotics, vaccines and diagnostics,” maintains the third article in the series.
Guarantee access
“The traditional drug development model, which relies on substantial revenue to motivate investment, is no longer economically viable without incentives,” he says. “Furthermore, medicines developed through these mechanisms are unlikely to be affordable for all patients who need them, especially in low- and middle-income countries.” The text advocates “new public financing models based on public-private partnerships” to support investment in antibiotics and novel alternatives, while reducing costs for patients.
Nour Shamas, 36, Lebanese, is a clinical pharmacist specializing in infectious diseases, and a member of the working group established in 2023 by the WHO of survivors of antimicrobial resistance. She knows the problem very well, not only because of her work, but because a few years ago, her mother, now 69, contracted a persistent and recurring urinary tract infection after being hospitalized for spinal surgery. Shamas values the measures proposed in the articles in The Lancet, But he warns that although they seem very simple, “each one has its difficulty.” “For example, washing your hands: even if you have clean water and soap, there may not be enough nurses in the hospital, so the ones that are there are very overwhelmed. Sometimes they don’t wash their hands, sometimes they wash them, but they don’t take 30 seconds to scrub. Or maybe they forget because they go from one patient to another. And sometimes people get tired and burn out,” he explains.
In a video call from Riyadh, where she works, Shamas recognizes herself as privileged to be able to afford the expensive antibiotics and tests that her mother in Lebanon still needs every two or three months. A country in crisis in which, even with money, it is difficult to find medicines. “We paid for laboratory tests to check what type of resistance she had and identify the best antibiotic to treat the initial episode. And now, every time she has the infection again, she has to take another test to know what antibiotic to use. Often she starts with one and after two or three days she has to switch to another,” she describes.
The WHO working group in which he participates, made up of 12 survivors or relatives of those affected (some of whose stories were cited at the beginning), has written a comment, also published in the scientific journal, that asks “all those who “They work on antimicrobial resistance that take into account the voice of the patient in their work and incorporate a people-centered approach.” “Antimicrobial resistance transcends borders and visa requirements and conflict zones. It can affect anyone, regardless of wealth, race or region around the world,” they recall.
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