A natural phenomenon, one of the main global public health problems, with health, social and economic consequences. Antibiotic resistance is the ability of a bacterium to resist the action of one or more antibiotic drugs, to survive and multiply even in their presence. For some time the WHO (WorldHealth Organization) has proposed guidelines and strategies to manage the phenomenon. The approach chosen is ‘One Health‘: evaluating the health of humans, animals and the environment in an integrated way.
The G20
The importance of the theme was reiterated at the G20 Health, the international summit on health issues that took place on 5 and 6 September in Rome, at the Capitoline Museums. “Antibiotic resistance is a silent pandemic, an ever-present threat,” he said Stella Kyriakides, EU Commissioner for Health and Food Safety, who reiterated the Union’s support for an international agreement on pandemics that includes provisions on antimicrobial resistance.
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History
Antibiotics have revolutionized the history of medicine. In 1928 the Scottish scientist Alexander Fleming first described penicillin, but by the end of the nineteenth century a medical officer of the Navy Health Corps was on the right track: Vincenzo Tiberio he had noticed how molds were able to kill some bacteria. It was at the end of the thirties of the twentieth century that Fleming’s studies were given vigor and in 1941 the first human being experimented with penicillin. Then the discovery of further classes of antibiotics, applied to various diseases. Until widespread use.
How do bacteria resist
Resistance can be natural or acquired, that is, stimulated by previous exposure to the antibiotic. It can be accelerated by inappropriate use and intake without medical advice. A “selective” pressure is thus exerted on the bacterial population, favoring the growth of strains with reduced or absent sensitivity to antibiotics. There are several mechanisms: the pathogen modifies the target of the drug (or replaces it), produces enzymes that inactivate it, uses systems that reduce its entry into it. “They are drugs that must be used correctly, only when necessary and after medical prescription. Better still with an antibiogram available, a test that shows how susceptible that bacterium is to one or more antibiotics – he says. Paolo D’Ancona, senior researcher at the Istituto Superiore di Sanità – Programs are being implemented in the hospital Stewardship antibiotics, in which the infectious agents, or dedicated teams, coordinate the use of these medicines throughout the care setting. We talk about perfecting choice, dosage, route and duration of administration. In community, however, it is more complicated. Despite the red prescription requirement, there is excessive use “.
The ‘worst’ bacteria
The expert also points out risk factors and more dangerous microorganisms. “In Italy, 8% of hospital admissions had an healthcare-related infection, almost always due to resistant pathogens, usually respiratory, urinary, blood or surgical wounds. In the past, Gram positive bacteria were heavily looked into. (Gram is a type of stain, ed) like it Staphylococcus aureus. Today the real danger comes from negative Grams, like Pseudomonas aeruginosa, Acinetobacter sp. e Klebsiella pneumoniae, in particular KPC, resistant to the antibiotic class of carbapenems. A delicate situation, because it is necessary to resort to combinations or other antibiotics, often highly toxic “.
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And give
D’Ancona reports an estimate for 2019: 33,000 deaths from antibiotic-resistant pathogens in Europe, 10,000 in Italy alone. Thanks to recommendations and initiatives from international organizations, the first results seem to be arriving, as the latest annual report demonstrates. Published last June, it analyzed data from 30 countries of the European Union and the European Economic Area that are part of the continental network for the surveillance of antibiotic consumption (Esac-Net), and those of 15 states of the AMC network (Antimicrobial Medicines Consumption ) of the WHO Europe: between 2014 and 2018, eight nations of the Esac-Net network showed significant reductions in the total consumption of these drugs (Denmark -2.5%, Finland -5.2%, Germany -3.4 %, Luxembourg -1.3%, Netherlands -1.5%, Norway -2.5%, Sweden -2.9% and UK -2.6%). “Awareness has increased – admits D’Ancona – but they are very slow processes. Significant changes will take longer”.
Covid
Same reason why the impact of Covid-19 cannot yet be assessed. “Initial data suggests that there have been no major changes in the rate of antibiotic resistance. Preventive measures (such as hand washing) in some settings have reduced health care-related infections. But the pandemic has also resulted in more hospitalizations. long and required a change in the treatment of mechanical ventilation, a risk factor for pathogenic microorganisms related to this care instrument. We have not yet published the 2020 results, but we believe that the situation has remained the same. Making a direct comparison is difficult ” .
