Antimicrobial Resistance: A Silent Pandemic

[This text was originally published in Catalan in EspaiS@lut newsletter of the Diputació de Barcelona. It has been updated in 02/02/2022]

Nowadays, most bacterial infections can be treated with antibiotics. This could change in the coming years: some disease-causing bacteria are developing mechanisms to evade the action of antibiotics, which means that, when an antibiotic treatment is started, it has no effect on the infection and alternative antibiotic treatments must be used. This phenomenon is known as “antimicrobial resistance”.

Although antibiotics are among the factors responsible for increasing our life expectancy, their indiscriminate use has led to the exponential rise of bacterial resistance, a global challenge that today already causes more than a million deaths worldwide (according to the latest study published very recently in The Lancet, 1.4 million people died in 2019 from infections attributed to resistant bacteria), a figure that could reach 10 million by 2050, making it one of the leading causes of death worldwide. COVID-19 has exacerbated the situation — only 8% of patients who consume antibiotics actually need them—making it even more urgent to raise awareness across society about antibiotic use, traditional medicine, and hygiene habits to prevent infections and disease spread.

1.4 million people died in 2019 from infections attributed to resistant bacteria, according to the latest study published very recently in 'The Lancet'

In keeping with this trend, we have seen the emergence of multidrug-resistant bacteria (or superbugs), which are resistant to several antibiotics, and even pandrug-resistant bacteria, which are resistant to all antibiotics. Moreover, few compounds with antibiotic potential have been developed in recent decades, due to the difficulty of accessing quality antimicrobials that are effective against these resistant species. This shortage is having a global impact, especially in health care systems around the world, resulting in high health care costs (across the European Union, antimicrobial resistance causes 2.5 million extra days of hospitalisation each year, costing approximately €900 million annually). Antimicrobial resistance is a particularly serious problem in southern Europe, due to the use and misuse of antibiotic treatments in this part of the continent.

Among the bacterial species that cause the most common infections in humans, the World Health Organisation (WHO) has identified the 12 bacterial families with the highest virulence and resistance to antibiotic treatment. These species are present throughout our environment, including in the livestock and agricultural sectors.

Antimicrobial resistance will be one of the leading causes of death worldwide by 2050

Hence, from a One Health perspective, antimicrobial resistance is considered a global health problem. More and more resistant bacteria are amplifying the ability of different types of resistance to spread to other bacteria and to the environment. If this trend continues, pandrug and multidrug resistance will become a reality for most bacteria. This means that we will be unable to use antibiotics to treat bacterial infections, leading to an increase in infection-related deaths.

Developing new antibiotic treatments is a very long and costly process, and unfortunately not enough resources are allocated to it. Hence the importance of regulating the use of antibiotics in both humans and animals. For some years now, various countries—or the European Union, in our case—have banned the use of antibiotics as preventive treatment or to promote the growth of livestock.

We also need to be aware of how antibiotic treatments should be taken. Antibiotics should only be used against existing bacterial infections, and it is important to complete the entire treatment regimen, as prescribed by a health professional, even if symptoms subside. These habits—together with hygiene and prevention habits such as frequent hand-washing, disposing of unused antibiotics at pharmacy-based collection points, avoiding activities associated with risk of exposure to bacterial infections, and following the vaccination schedule—are among the actions we all must take in order to slow the advance of antimicrobial resistance, which is already a reality, and prevent the advent, in a few decades’ time, of the post-antibiotic era, when modern medicine as we know it today will no longer be possible.

We need to be aware of how antibiotic treatments should be taken. Antibiotics should only be used against existing bacterial infections, and it is important to complete the entire treatment regimen, as prescribed by a health professional, even if symptoms subside

It is essential to spur interest and raise awareness in order to build a society equipped to take preventive action in the face of potential global threats, such as the one we are currently facing with COVID-19, as well as another, silent pandemic: antibiotic resistance.