Every day, millions of doctors are faced with people suffering from diseases caused by one or more bacteria. However, it is becoming increasingly difficult to eradicate them from the body due to the resistance they display, a fact that is certainly already worrying the scientific and medical community, but which should be of concern to everyone.
According to the World Health Organization According to the WHO, by 2050 there will be more deaths related to superbugs than cancer, and they will be the main cause of death on the planet.
The study was published in 2017, three years before the COVID-19 pandemic, caused by the SARS-CoV-2 virus, and at the time scientists had no idea that this disease would lead to excessive and incorrect use of antibiotics.
The bacteria Helicobacter pylori, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae and Salmonella spp are some of the microorganisms that have recently shown higher levels of resistance to various generations of antibiotics and that put the health of the population at risk.
A list that, unfortunately, is growing ever longer and makes antimicrobial resistance a public health problem today, classified in 2020 by the WHO within the list of "urgent health problems of global dimension".
The causes, says the WHO, are due to "a myriad of factors that have combined to create a terrifying cocktail, such as the unregulated prescription and use of antibiotics; lack of access to quality medicines at affordable prices; lack of clean water and sanitation services; and lack of infection prevention and control."
However, although the situation is more critical in marginalized and poor regions, with health crises, lack of water and inadequate hygiene and habits, worrying levels of resistance to some bacterial infections have been found in low-, middle- and high-income countries; in men and women, regardless of age, race or social status, so this is a global problem.
An example of this is that a study led by experts from the Global Antimicrobial Resistance Surveillance System (GLASS), supported by the WHO, revealed the widespread presence of antibiotic resistance in samples from 500,000 people from 22 countries, in whom bacterial infections were suspected, with a wide variation from 0 to 82 percent in at least one of the most commonly used antibiotics.
Another study, by the Organisation for Economic Co-operation and Development (OECD), speaks of "a worrying phenomenon of expansion, which could cost the economies of its member countries 3.5 billion dollars annually."
The WHO's list of priority pathogens included how fatal the infections they cause are; whether or not treatment requires prolonged hospitalization; how often they are resistant to existing antibiotics; how easily they are transmitted between animals, from animals to people, and between people; whether or not the infections they cause can be prevented – for example, through good hygiene and vaccination; how many therapeutic options remain; and whether new antibiotics are being researched and developed to treat the infections they cause.
The critical priority list includes multidrug-resistant bacteria that are especially dangerous in hospitals, long-term care homes and among patients who need to be cared for with invasive devices such as ventilators and intravenous catheters.
High and medium priority levels include bacteria whose drug resistance is increasing and which are related, in many cases, to community-acquired diseases, such as gonorrhea or Salmonella food poisoning.
But what are superbacteria and how do they manage to resist antibiotics?
Superbugs are strains of bacteria that have become resistant to known antibiotics, often including the most modern ones, and they try to survive external attacks and have an added advantage because they are highly capable of mutating and reproducing.
Under the right conditions, hundreds of millions of them can appear within a few hours. This allows their mutations in DNA to occur relatively quickly, and if these modifications prove useful and survive, this mutation can be further refined.
Superbugs occur due to the overuse of antibiotics, as when they are used too much or incorrectly, the bacteria that have caused the disease in question become overexposed and produce mutations in an attempt to survive.
The above is known as "genetic capitalism"; a resistant bacteria has an evolutionary advantage, meaning that it not only tends to persist, but is also more likely to continue acquiring resistance mechanisms.
In addition, no matter how modern or sophisticated antibiotics are, bacteria will continue to perfect their mutations and the more they are abused, the more bacteria will evolve to resist them. This is a problem that can no longer be reversed.
The WHO established three groups of multi-resistant bacteria, depending on their priority.
- Priority 1 or critical, where all are resistant to carbapenems, the so-called broad-spectrum antibiotics, are Acinetobacter baumannii, Pseudomonas aeruginosa, some enterobacteria such as Klebsiella pneumoniae, Escherichia coli and several species of the genera Serratia and Proteus.
In the case of Klebsiella, cases have already been found in which no antibiotic is effective anymore.
- Priority 2 or high. This level includes Enterococcus faecium, which is resistant to vancomycin; Staphylococcus aureus, which is resistant to methicillin and vancomycin; Helicobacter pylori, which is immune to clarithromycin; Campylobacter spp and Salmonella, both resistant to fluoroquinolones; and Neisseria gonorrhoeae, which is resistant to cephalosporins and fluoroquinolones.
- Priority 3 or medium. They include Streptococcus pneumoniae, which are no longer sensitive to penicillin; Haemophilus influenzae, resistant to ampicillin; and Shigella spp. immune to fluoroquinolones.
Since the problem cannot be reversed, the problem can be slowed down by avoiding self-medication and allowing antibiotics to be prescribed by a doctor. In addition, they should be avoided for diseases that have a viral origin, such as the flu.
It is important to understand that the antibiotic treatment must be completed and not stopped as soon as the symptoms disappear, since if the treatment is stopped early, the bacterial infection may not be completely eliminated, causing it to adapt to the antibiotic and become resistant to it.
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