Bacteria resistant to all medicines known to man have already appeared in the world. Will there be no treatment for severe infections soon?
It happened less than a year ago. New Zealand doctors have long been trying to cure one of their patients of infection with Klebsiella pneumoniae, a common microbe that causes pneumonia around the world. Until recently, the infection was treated with it without any problems with a well-chosen antibiotic. However, in this case, subsequent attempts to select an antibiotic did not help. Doctors have tried the entire arsenal of drugs available. In vain. The patient died. This incident was widely reported in the media, as New Zealand’s K. pneumoniae was considered to be the first bacteria resistant to absolutely all antibiotics. So a superbug.
A cure for all evil?
Doctors and scientists have long feared that bacteria would eventually outsmart us and become resistant to the drugs we have today. Fortunately, the New Zealand case is still isolated, but it is known that more and more bacteria that attack humans are becoming resistant to the most commonly used antibiotics. This is due both to the defense mechanisms of the microbes themselves and the uncontrolled use of antibiotics by patients and the widespread prescription of these drugs by physicians to patients who do not really need them. And this is how we grow more strains of superbugs.
The data from the National Health Fund show that a statistical Pole is prescribed an antibiotic every year, and many people take this drug several times a year for diseases of the upper and lower respiratory tract. It is not much better among children – the analyzes carried out in 2008 show that as many as 67 percent. the children had taken antibiotics in the previous year. It’s the same all over the western world. Americans are alarming that their doctors often prescribe antibiotics unnecessarily to people with infections of the upper respiratory tract. Research conducted at the University of Chicago shows that, especially in hospitals, this practice is common – a patient who develops a respiratory infection gets an antibiotic almost immediately.
Very often, the sick themselves, inadequately or incorrectly using an antibiotic, contribute to the increase in bacterial resistance, and hence, the lower and lower effectiveness of the drug. – A patient who uses antibiotics contrary to the doctor’s recommendations: too short, too small, modified doses, in inappropriate time intervals significantly increases the probability of selecting resistant strains – says Dr. Katarzyna Fleischer-Stępniewska from the Department and Clinic of Infectious Diseases at the Medical University of Wroclaw. – Topical antibiotics in the form of ointments or gels also play an important role in the formation of resistant strains, because in this situation it is not possible to control the proper content of the antibiotic at the site of its action.
How they do it
Bacteria build up their resistance very easily. Genes located in circular fragments of DNA, called plasmids, are responsible for its occurrence. “One plasmid may contain genes for resistance to several different chemotherapeutic agents. Plasmids can transfer resistance genes from one bacterial cell to another “, write in their article in” Medycyna Rodzinna “, Elżbieta Mazur and Sebastian Klag from the Medical University of Lublin. By transferring genes to an antibiotic, whole colonies of microbes become resistant to resistance. Additionally, some of them are smart enough to pass on information about drugs. For example, the very dangerous blue oil bacteria, Pseudomonas aeruginosa, which are a frequent cause of nosocomial infections, secrete enzymes and information carriers when they sense the presence of antibiotics. With their help, they warn themselves of the danger. As a result, bacteria in the colony immediately encapsulate a tight biofilm. Thanks to him, microbes become resistant to even the strongest drugs.
There are more and more such bacteria. – The occurrence of multi-drug resistant strains, initially recorded mainly in the hospital environment, is also becoming common in the non-hospital environment – says Dr. Katarzyna Fleischer-Stępniewska. – Bacteria such as methicillin-resistant staphylococci, abbreviated MRSA, already in the 90s in the USA caused outbreaks of skin and soft tissue infections, as well as respiratory tract infections in previously non-hospitalized people, hence these strains were called CA-MRSA (community associated MRSA). Currently, also in Poland, they are more and more often the cause of infections in outpatients.
Of course, there are strains of bacteria that are less and more dangerous to our health. – If we were to select the most difficult to control, we would certainly mention multidrug-resistant tuberculosis, nosocomial infections involving Gram-negative bacilli resistant to everything except colistin (not always clinically effective) and post-antibiotic diarrhea caused by Clostridium difficile, especially the epidemic strain of NAP -1 – says Dr. Stępniewska. Infections with Klebsiella pneumoniae, which have resisted all treatment methods in New Zealand, are very dangerous. – Already at the end of the 90s in the USA, infections with the participation of Klebsiella pneumoniae strains resistant to almost all available antibiotics, and now these bacteria are responsible for epidemic outbreaks of nosocomial infections in all regions of the world – says Dr. Stępniewska.
Viruses to bacteria
Of course, doctors and scientists, aware of the rapid deterioration in the effectiveness of antibiotics, rush to look for new drugs. Every now and then there are reports of new therapies or drugs that could replace today’s antibiotics in the future. Great hopes are associated with phage therapy, which is also being developed in Poland by the Phage Therapy Center of the Institute of Experimental Medicine of the Polish Academy of Sciences in Wrocław. Bacteriophages, or phages for short, are viruses that can attack bacteria. Most often, one type of virus can destroy only one strain of bacteria, but it does it so effectively that phage therapy is already carried out in patients with infections with antibiotic-resistant bacteria. The therapy, however, has a lot of limitations – the viruses used are not always able to cope with a strong infection, bacteria on their part quickly develop resistance against viruses as well as against antibiotics. Phage therapy is also not fully tested in terms of its safety. Nevertheless, doctors and scientists involved in its development hope that in the future, phages will be an effective remedy for antibiotic-resistant bacteria.
For now, it would be best to find new, effective antibiotics. However, those in pharmaceutical laboratories are like medicine. – In the near future, new antibiotics or chemotherapeutic agents will not be introduced into therapy, so we must maintain the effectiveness of those that are currently available – says Dr. Stępniewska. Therefore, it must be remembered that the antibiotic should only be used when necessary. Antibiotics do not work against viruses, they are not antipyretic drugs, so they will not be effective, for example, in colds. They also have a lot of side effects. – Frequent or long-term therapy weakens our own physiological flora, which may increase the susceptibility to infections, including, as a result of disturbances in the composition of the flora, it may lead to the development of diseases such as the aforementioned post-antibiotic diarrhea or fungal vaginosis – warns Dr. Stępniewska.
Remember that antibiotics are still great drugs, our secret weapon in the most severe infections. But for the weapon to remain effective, we must not allow the enemies – the superbugs – to work it out.
Wojciech Marlicz, MD, PhD
Antibiotic resistance is one of the most important problems of modern medicine. Harmful bacteria in the situation of frequent and incorrectly conducted antibiotic therapy can develop defense mechanisms against antibiotics. This reduces their effectiveness, thus reducing the chances of a complete recovery. Treatment with antibiotics also carries the risk of side effects, such as diarrhea, nausea, abdominal pain, loose stools. All these problems are related to disturbed microflora in the intestines. Antibiotics disrupt the composition of beneficial intestinal bacteria, causing the so-called dysbiosis. The related growth of pathogenic bacteria contributes to the ailments described above. In addition, dysbiosis can leak the protective intestinal barrier. It is associated with the possibility of the penetration of dangerous toxic substances into the bloodstream, thus causing chronic inflammation in the body.
In order to prevent side effects associated with antibiotic therapy, it is recommended to use antibiotics together with preparations containing probiotic strains. By supplementing the natural, normal intestinal microflora, probiotics prevent the development of pathogenic microorganisms in the gastrointestinal tract, increase the effectiveness of antibiotic treatment and reduce the risk of antibiotic resistance among pathogenic strains.
Author Side Agate