One of the Top 10 threats to health of human beings is the resistance of pathogens to antimicrobial drugs, such as antibioticsand the situation It is increasingly worrying.
The World Health Organization (WHO) has just published a new list with 15 families of bacteria resistant to antibioticsto which both health professionals and the community in general should pay more attention.
They had already published the first list in 2017. But there were advances in some resistant bacteria and changes in the monitoring methodology that forced a new version to be made. These “superbugs” are classified into three categories:
- Critical priority
- High priority
- Medium priority
In the first category These are the most difficult superbacteria to control today. The bacteria was included there Acinetobacter baumannii that offers resistance to carbapenems and enterobacteria that are resistant to these types of medications and cephalosporins third generation. Infections caused by these pathogens are generally acquired as a consequence of health-related care in hospitalized patients.
Furthermore, in a “critical” situation is the bacteria that causes tuberculosis, the so-called Mycobacterium tuberculosis, is resistant to the action of the drug rifampicin. In the report, experts from WHO They explained that they placed it in that category because of “its ability to transfer resistance genesthe severity of infections and diseases and the high burden of disease they produce worldwide, particularly in low- and middle-income countries.”
Among the pathogens of high prioritythey find the Salmonella and the Shigella, which can be transmitted through the consumption of contaminated water or food, among other ways, and cause a lot of morbidity and mortality in low- and middle-income countries. In these bacterial genera, a high proportion with resistance to fluoroquinolone drugs has been detected..
Others that are disturbing are the Pseudomonas aeruginosa and Staphylococcus aureus, which cause infections associated with health care in hospital establishments. Also the Neisseria gonorrhoeae which causes gonorrhea – a sexually transmitted infection – and enterococci E. faecium resistant to vancomycin pose specific problems for public health.
Meanwhile, among the pathogens of medium priority the streptococci of groups A and B. This includes he Streptococcus pyogenes, bacteria that can cause sore throat and scarlet fever. But they can also cause more serious disorders, such as streptococcal toxic shock syndrome. At the end of 2022, the increase in cases of affected people was detected by S. pyogenes in Europe and then in Latin America and Asia.
Due to the level of resistance they develop, pneumococcus (Streptococcus pneumoniae) that produces pneumonia and meningitis and the bacillus Haemophilus influenzae give rise to a high burden of morbidity.
“These pathogens require greater surveillance, especially in vulnerable populations, such as children and the elderly, especially in low-resource areas,” the experts warned. To prevent infection by these two pathogens, vaccines are available, but not all of the population that should receive them have access to their application in time.
In dialogue with Infobaethe doctor Alejandra Corsoin charge of the Antimicrobial Service of the ANLIS/Malbrán Institutein the Argentinaa PAHO/WHO collaborating center, considered: “The new list of resistant pathogens that was disseminated is a key tool not only for more investment in the development of new antibiotics, but also for strengthening epidemiological surveillance and improving diagnoses. on time”.
The 15 families of resistant pathogens on the list are present in Latin America, and “the situation is worrying and after the public health emergency due to COVID-19 “Everything got worse,” said the scientist.
It is important – he stressed – that “the new version takes more into account the impact of resistant pathogens in low- and middle-income countries. Its dissemination is also a way to raise awareness about the problem to reduce the inappropriate use of antibiotics. Promotes the implementation of antimicrobial optimization programs in hospitals.”
Dr. Corso clarified that some of the resistant pathogens can be acquired while hospitalized. But there are also other cases, such as that of the bacteria that causes gonorrheapneumococcus or streptococcus that can be acquired in the community.
He United Nations Environment Program has clarified that, in addition to the misuse of medicines (both in humans and animals), there are other factors that drive the problem: the lack of safe water and sanitation, pollution derived from the production of pharmaceutical products, livestock, aquaculture, intensive crop production, migrations, loss of biodiversity and climate change.
Yesterday, during the 77th World Health Assembly, which is the supreme decision-making body of the World Health Organization, a round table was organized on the problem. “This crisis remains silent. We assume that infections that once caused death are routinely cured with antibiotics. In the era of increasingly advanced and personalized medicine, we have become complacent with these wonders that allowed us to control infections,” he said. Peter Piotprofessor of Global Health at the London School of Hygiene and Tropical Medicinein the United Kingdom.
“We run the risk of returning to the era before antibiotics, which is even more threatening given the demographic transition and aging that the world is experiencing,” he warned.
Faced with the problem, there are possible solutions, which require the participation and commitment of everyone, from public health political authorities to health professionals. From animal producers to the community at large, they should only use antibiotics when appropriate.
“During recent years, new drugs have been developed, but the limited access to their use should be taken into account. The high cost prevents them from being administered to many patients with resistant bacteria. The time to diagnosis of infection should also be shortened as is the initiation of appropriate antimicrobial therapy. In severe infections such as sepsis, For every hour of delay in diagnosis, the patient’s risk of mortality increases by 7%”said Dr. Corso.
Recently, a group of specialists from the Argentine Society of Infectology (SADI) presented preliminary results of the study EMBARK in the 34th congress ESCMID Global in Barcelona, Spain. This study was carried out between July 2020 and March 2022 in 34 health care centers in Argentina.
They analyzed data from 140 patients with bacteremia caused by Enterobacteriaceae (which are in the “critical priority” category on the WHO list). They found that there was elevated resistance to multiple groups of antimicrobials, including aztreonam. Regarding the evolution of the patients, a mortality rate of 41% at 30 days was observed.
“With the pandemic, the problem of antibiotic resistance accelerated. There are limitations in the access and availability of useful drugs for infections by these superbugs on the list of WHO. There are also serious deficiencies in infection control programs and in the responsible use of antibiotics in both the public and private spheres,” he stated. Francisco Nacinovichmember of the SADI and was co-founder of the non-profit civil association INVERA dedicated to research on antimicrobial resistance.
“We must reserve antibiotics for real needs, while aggressively developing new drugs, diagnostics, vaccines and non-pharmaceutical options,” Piot said at yesterday’s roundtable. And we must ensure that second- and third-line antibiotics are commercially viable once on the market. Equally urgent is the public and global sharing of national data on emerging resistance. There is no time to waste: we must act decisively today to fight AMR or tomorrow we will lose much of the advances in health and modern medicine that we have worked so hard to achieve.”
