In mid-2023, an 80-year-old man was admitted to the emergency room of a hospital in Buenos Aires due to an infectious psychosis. “I was delirious; “He was so out of it that we had to give him a sedative to be able to examine him,” he recalled in an interview with SciDev.Net Yinier Hinestroza, one of the doctors who treated him.
Bacteria were responsible Klebsiella pneumoniae settled in his bladder. For five days the patient had not improved with the antibiotics he was prescribed to take at home and the fever was beginning to wreak havoc on his body, immunosuppressed by a cancer he suffered in the past.
A laboratory analysis of blood samples called a blood culture revealed the presence of the feared strain known as KPC. “We call it a superbacteria,” says Hinestroza, “because it is a Klebsiella pneumoniae resistant to almost all first, third and even fourth line antibiotics.”
Amplified image of the Klebsiella pneumoniae bacteria that presents multi-resistance to first, third and even fourth line antibiotics. Image credit: US National Institute of Allergy and Infectious Diseases (NIAID), licensed under Creative Commons CC BY 2.0 Deed.
The emergence and silent spread of these types of microbes may have been exacerbated by what the World Health Organization (WHO) called “excessive and widespread use” of these drugs around the world during the COVID-19 viral pandemic. 75 percent of hospitalized people received antibiotics, although only 8 percent required them due to bacterial coinfections, detailed in a recent statement.
The findings are based on data from the WHO Global Clinical Platform for COVID-19, an anonymized clinical data repository that collected information from about 450,000 patients admitted to hospitals for COVID-19 in 65 countries between January 2020 and March 2020. 2023.
Likewise, the WHO warned that antibiotics with a high possibility of generating resistance – such as azithromycin or ceftriaxone – were the most prescribed. Since these medications do not act against viruses, their prescription ‘just in case they were helpful’ not only did not benefit the clinical evolution of the patients, but there were cases in which it was associated with a 20-fold increased risk of death.
“The population must be made aware that the majority of gastrointestinal and respiratory infections are viral. If they use antibiotics in these cases, the only thing they will do is generate colonies of resistant bacteria in their body.”
Patricia Cornejo Juárez, president of the Mexican Association of Infectology and Clinical Microbiology
“These data teach us several lessons. The most important is that starting antibiotics blindly is of no use. Currently there are better diagnostic methods and if the bacteria do not grow or we do not document them with these tools, then the use of antibiotics is not justified,” he warned. SciDev.Net Patricia Cornejo Juárez, president of the Mexican Association of Infectology and Clinical Microbiology.
Adequate antibiotic intervention in Latin America faces several challenges. In a survey — administered in 42 hospitals in Guatemala, Panama, Ecuador, Colombia and Argentina — 51 percent of health workers noted the lack of access to tests to identify resistant infections. Additionally, 22 percent of prescribers admitted to not having received training in selecting antibiotics based on culture results (see infographic).
Another challenge in the region is self-medication with antibiotics which, according to a recent review that analyzed articles published between 2019 and 2023 in English, Spanish and Portuguese; It ranges between 14 and 80 percent, depending on each country. Peru, according to this study, registered 80 percent self-medication, Colombia between 24 and 47 percent, Brazil between 24.6 and 53.8 percent, among others.
Likewise, another research carried out by the University of Oxford in 35 Latin American countries found that, in 2019, at least 569,000 deaths were related to bacterial antimicrobial resistance (AMR). The five countries with the highest mortality were Haiti, Bolivia, Guatemala, Guyana and Honduras.
Sonia Urrutia, for example, learned from her mother to use them on her own when faced with the slightest discomfort: “It’s something super reckless,” she told SciDev.Net from Santiago de Chile. “I obviously never taught my children the same thing because I had consequences,” she added.
This 52-year-old woman has been suffering from multidrug-resistant infections for just over a decade. The last one occurred in January 2024, when a culture of her urine detected bacteria that do not give in to an entire family of antibiotics, beta-lactams. Urrutia was hospitalized for seven days at the Santa María clinic with the only intravenous treatment available.
Antibiotics should only be used by prescription. Self-medicating with them is a practice that can have dire consequences in the future. Image credit: OPS/Flickr, under Creative Commons CC BY-NC 2.0 Deed license.
“The population must be made aware that the majority of gastrointestinal and respiratory infections are viral. If they use antibiotics in these cases, the only thing they will do is generate colonies of resistant bacteria in their bodies that can be transmitted and proliferate in the most vulnerable groups, such as people with cancer, diabetes, malnutrition or obesity,” said Cornejo Juárez.
These impacts are added to those of the livestock sector, which alone consumes 66 percent of antibiotics globally. They are used to treat infections on farms and increase the size of livestock, but this last practice has been ruled out as veterinary use because it violates the international standards of the World Organization for Animal Health and compromises the fight against bacterial resistance.
In the Latin American context, a study found that only three of the five large meat producers—Argentina, Chile and Colombia—have regulations classified as “strong” to limit the use of antibiotics as growth promoters. The other two—Brazil and Uruguay—have “intermediate” legislation, and all of them lack information on compliance with those laws.
The indiscriminate use of antibiotics is the main accelerator of bacterial resistance and in the region it is associated with the emergence of this characteristic in at least eight species of bacteria, suggests a review of research published in the last decade.
Alejandro Macías—infectologist with more than 30 years of medical practice and professor at the University of Guanajuato in Mexico—said to SciDev.Net that the scenario where absolutely no antibiotics work is still rare, but other manifestations of bacterial resistance are an everyday problem.
“Typically, people come in with urinary tract infections that no longer respond to oral antibiotics. So we have to escalate to injectable options, increase the doses, there are greater side effects and the cost also rises, both for families and for health institutions,” Macías commented to SciDev.Net.
This is what happened with Yinier Hinestroza’s patient from Buenos Aires. After 30 days of battle in the hospital, under strict isolation and close to exhausting the entire arsenal of antibiotics, he survived. However, he went home with irreversible consequences.
Not everyone makes it. An investigation at the end of 2023 published in the journal Emerging Infectious Diseases estimated that in Latin America the fatality rate of multidrug-resistant bacteria is 45 percent. That is, almost 1 in every 2 people who acquires one of these infections dies. With these figures it could become the main cause of death in the world, if something is not done about it.
This article was produced by the Latin America and Caribbean edition of SciDev.Net
