Resistance to antibiotics, why it is scary and what the risks are

AMR. Remember this international acronym, which stands for Anti Microbial Resistance. It is a voice that will increasingly enter into health-related issues. Why antibiotic resistance is and is destined to become one of the great alarms for global well-being, with a heavy impact on public health and important implications both from a clinical and economic point of view.

Just think that in Italy in 2021, 62,833 pathogens were isolated and the percentages of resistance to the main classes of antibiotics remain high, so much so that our country is at the bottom of the rankings the incidence of resistant bacteria. But the problem is certainly broader, to the point of resonating as a global emergency. To understand the extent of what is happening, just reread a recent scenario developed by the WHO: it is expected that by 2050 the leading cause of death will be infections from resistant germs with a number of lives lost, 10 million, higher than the deaths currently linked to tumors. In Europe, 392,000 deaths are estimated: 120,000 in Italy alone.

What happens if we use antibiotics incorrectly

Bacteria are by nature mutants. And above all they are terribly quick to reproduce. If they find optimal conditions they can double in number every twenty minutes. L'antibiotic, especially if used improperlycan become a sort of “stimulus” to trigger a series of natural survival mechanisms that the bacterium implements to escape the attack of the drug and to preserve the species.

The means through which resistance is created are multiple. To escape the antibiotic, the germ can, for example, “mix” some portions of its genetic material with that of another species, taking on its resistance characteristics. Sometimes, however, a bacteriophagea sort of “transmission belt” that allows the germ to incorporate genes from another bacterium, or it can even happen that a fragment of DNA passes from one bacterial cell to another, modifying the invisible “attachment points” of the antibiotic.

The result of all these steps is that the antibiotic, no longer finding the “handholds” necessary to kill the bacterium, becomes ineffective. It should also be remembered that the genes that favor resistance can overcome the “species” barrier of the host, so they are also transmitted very easily from one species to another and also in particular situations, such as for example in animal husbandry or in agriculture.

How important is the improper prescription of antibiotics?

“The growing expansion of multidrug-resistant microorganisms has many explanations, but certainly theoverprescribing of antibiotics represents a significant factor in the selection of resistant species – Pierluigi Viale, Director of Infectious Diseases at the Sant'Orsola-Malpighi Polyclinic of Bologna and Full Professor of Infectious Diseases at the university, recently underlined while presenting an initiative of the SITA (Italian Antibiotic Therapy Society). Bolognese – it's a sort of Darwinian mechanism therefore in a microbial population of enormous dimensions, which colonizes our entire ecosystem, prolonged antibiotic therapy, with too broad a spectrum, repeated several times represents a stress factor that generates selection of resistant strains”.

The specter of a pre-antibiotic era, which it would take us back a hundred yearsis inexorably affecting global public health due to antibiotic-resistant superbugs.

Why bacteria become resistant even “at the table”

In theory, there are several opportunities for a bacterium to become resistant to an antibiotic at some point. Let's go in order, starting from table. The bacteria present in foods, completely harmless in terms of health, could become a sort of “vehicle” of resistance. In fact, they could allow a sort of “horizontal transfer” of bacterial resistance genes, which pass through a commensal microorganism for the human body and until reaching pathogenic germs. These, in the subsequent stages of development, incorporate into their genome the invisible genetic trait that makes them impervious to a specific antibiotic, and their “lineage” retains this characteristic, therefore becoming resistant to antibiotic therapy.

Indict only the foods, however, would be reductive and inappropriate. Because the transfer of resistance genes from “good” to “bad” bacteria increasingly appears as an engaging phenomenon the environment in which we live. This is proven by some studies conducted on exclusively breastfed infants who had never consumed any food other than breast milk: their intestinal flora harbors bacteria that they have in their genetic heritage. the typical traits of resistanceand therefore they can “transfer” them to other bacteria.

Why it is difficult to find new antibiotics and how important vaccines are

Some have been developed or are in progress in the last decade new antibiotic molecules. But in general terms the research and development of these drugs presents itself difficulty for several reasons, firstly because these superbugs are 'opportunists', threatening the lives of fragile and compromised patients with various comorbidities and secondly because enrolling adequate numbers of vulnerable patients to have clinical trials with adequate evidence of efficacy is not easy.

To combat multi-resistant germs it is therefore research needs to be strengthened And encourage the use of new antibioticsreal lifesavers like anticancer drugs, overcoming the paradox of not treating an infection today for fear that it will become more serious or less curable tomorrow.

Is critical carry out research to identify new drugs and enhance innovative antibiotics, which when inserted into adequate therapeutic schemes also allow us to protect the efforts and investments made to support the patient's health with enormous savings in resources. In this sense, however, also Vaccine research appears important: if new vaccines are found for bacterial strains that do not yet have a preventative modality of this type or in any case make the best use of those available, the risk of having to use antibiotics to fight bacterial infections which sometimes do not develop independently, but sometimes they overlap with viral ones.

Are new rules needed for antibiotics in study?

Having said that it is easier to identify a new antibiotic within an already existing family, rather than finding different ones, it must be remembered that developing a new antibiotic is extremely expensive and ideally the drug will be used for a limited number of patients, those infected with resistant bacteria. For this reason ltreatment tends to be very expensivemore or less as happens in the case of therapies for rare diseases.

But it is a necessity: to extend the use of a new drug to non-resistant bacteria it would allow a lower cost, but could increase the risk of resistance. Finally, it should not be forgotten that the antibiotic is “different” compared to other drugs: often these drugs have been isolated from microorganisms such as fungi or bacteria that must compete with other species in their environment. For this reason it is necessary to think of different ways, such asassociation between two drugs: it is known that a bacterium becomes less resistant when exposed to two different antibiotics.

Who most needs targeted antibiotics

Let's be clear: it is necessary much attention to prevention. Especially in hospitals and nursing homes, to contain infections and bacterial transmission. But with the certainty that in any case there will be more and more fragile subjects potentially exposed to healthcare-related infections.

Paradoxically, the risks increase because medicine advances. Advances in surgery, transplantology and oncology have in fact saved more and more lives, making them more susceptible to the risk of hospital infections. This is why they are needed new tailor-made antibiotics for the most fragile patients such as the elderly, patients undergoing organ transplants or oncological treatments, those in intensive care or who have undergone major surgical operations, whose outcomes are penalized by the lack of new antibiotics which also risks paralyzing such activities, especially in the most complex cases.

This is also why the aim is to equalize the regulatory requirements of new antibiotics with those of anticancercreating 'fast track' and accelerated and simplified regulatory pathways for the approval, marketing and regional introduction of life-saving medicines.

Five rules to better control infections

  • Wash your hands frequently and carefully throughout the day;
  • Put your hand or a tissue in front of your mouth when you sneeze;
  • Use antibiotics appropriately only when prescribed by your doctor;
  • Don't take antibiotics for the common cold or flu;
  • Use antibiotics respecting the dosages and times prescribed by your family doctor and always complete the treatment cycle even if you feel better.