In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
10 million people will die in a year from infections for which there is no cure. Bacteria are smarter than humans. And in the hands of terrorists, they are more dangerous than the shahid belt.
We talk to prof. Waleria Hryniewicz, national microbiology consultant and dr. Tomasz Ozorowski, a microbiologist.
We are in 2050. We will continue to fight bacteria, or maybe we will all be infected?
Prof. Waleria Hryniewicz: Jim O’Neilla’s report – prepared on the orders of the then British Prime Minister David Cameron – on the threats for the future, showed clearly what will happen to the world and us – patients – due to antibiotic resistance. If we do not act immediately to fight antibiotic resistance, 2050 million people will die from infections that cannot be treated by 10.
It is getting more and more real?
Prof. Waleria Hryniewicz: Yes, it is supported by very accurate and reliable reports by the analyst, economist. This is not reading tea leaves.
Will we only be threatened by superbugs? Will those we know and know how to fight them also become dangerous?
Prof. Waleria Hryniewicz: Evolution is going in that direction. First of all, bacteria share knowledge with each other, and they do it very quickly and significantly. In addition, they acquire new resistance mechanisms, mainly due to the abuse of antibiotics and their inappropriate use. I think that more and more new species will enter our hospitals. We must remember that the world’s population, especially in the Western world, is aging and, as a result, the number of patients susceptible to infection will increase. Also thanks to the achievements of medicine, we have younger and younger patients who also still have immune deficiencies and cannot cope with the simplest infections.
Will the same bacteria be able to “go” outside the hospital?
Dr. Tomasz Ozorowski: There are two types of infections – nosocomial and non-nosocomial. Nosocomial infections are unlikely to be carried home. This infection most often affects people who are hospitalized because of illness and undergo procedures that expose them to nosocomial infection. It is about surgery, catheter placement and indeed these infections are becoming more frequent. But they are unlikely to be feared, and will rather remain in a hospital setting. They are definitely losing out to those bacteria outside the hospital.
Prof. Waleria Hryniewicz: Dr. Ozorowski, unlike me, is more optimistic. Although I do not deal with nosocomial infections as intensively as he does, I do not share this opinion. Very often, such typical community-acquired pathogens, e.g. pyogenic streptococci, have resistance mechanisms that are of concern. This bacterium most often causes angina, and this can be perfectly cured with penicillin. The problem arises when we have a patient we cannot give it to. Although we have second-line drugs at our disposal, i.e. macrolides, bacterial resistance to them exists and is increasing. This process is slower, but if we have problems with such a patient, we send him to the hospital for treatment. Because there’s a bigger arsenal of drugs out there. I would be very careful to say there is no problem outside the hospital.
But we never know what this hospital is like.
Prof. Waleria Hryniewicz: We must also take into account that bacteria such as salmonella, Helicobacter, i.e. common community bacteria, are increasingly resistant to drugs. The list of dangerous bacteria created by the WHO includes gonorrhea, which is a typical community-acquired infection and increasingly there are no medications available for it.
Does this mean that in the fight against these “known” bacteria, we also lose and become powerless?
Prof. Waleria Hryniewicz: We are afraid of that. Because here the basis is two or three drug therapy. And if one drug becomes ineffective, there is great concern that the bacteria will quickly become resistant to both drugs. There is also a danger in relation to community-acquired pathogens because this resistance will continue to increase. An excellent example are pneumococci, where resistance to first- and even second-line drugs is increasing.
So bacteria are smarter and smarter than humans?
Prof. Waleria Hryniewicz: Bacteria adapt very quickly to the new situation because they want to live. They have a very plastic genome. They donate and acquire resistance genes very easily so that they can survive. In fact, bacteria double their population very quickly. In the case of E. coli, a very common bacteria, it takes only 20 minutes. If one bacterium out of the whole mass of microbes survives under the action of an antibiotic and becomes resistant and starts to multiply, after 20 minutes we have two resistant cells. And so on and so forth. Today, this process is happening much faster and on a larger scale, all because we overuse antibiotics.
Today – at least we have so far – antibiotics. What will happen next? Do we have any alternative?
Prof. Waleria Hryniewicz: We are trying to create new vaccines, but it fails that easily. There are too many kinds of all these microorganisms. In addition, new ones are constantly added and the development of vaccines is not possible. Scientific research is helpful in fighting them. Thanks to a better understanding of bacteria, it may be possible to determine when and at what stage of their development we can harm them. There is talk of drugs that will inhibit certain metabolic pathways that are crucial for their life, and may cause them to stop secreting toxins, which cause symptoms in many diseases. In addition, research is stimulated and huge amounts of money are spent on developing new drugs. However, there is no simple solution. We are trying to put old antibiotics in new carriers so that they are more effective and can reach the site of infection in higher concentrations and increase the chances of a cure. Unfortunately, at the moment there are very few successes in finding new drugs and therefore increasing the control of nosocomial infections is a key activity.
The doctors themselves should also be made aware of the fact that they prescribe antibiotics and are not aware of the risk.
Dr. Tomasz Ozorowski: We know that up to 70 percent. Antibiotics are prescribed unnecessarily, but that’s just one piece of the puzzle. Educating doctors and telling you what to do to prevent overuse of antibiotics is also very important. Most often they prescribe them for infections of the upper respiratory tract. But the problem is with the hospitals themselves. There is still a strong belief that it is better to administer an antibiotic than not. They are very often prescribed prophylactically.
Since there is so much talk about it, where does this problem come from?
Dr. Tomasz Ozorowski: This is a relatively young problem. In fact, medicine has been dealing with the issue of antibiotic resistance for 3-5 years. It was around this time that the first reports of the problem began to appear. At the same time, we have few tools to define what this problem looks like in Poland. We do not have a good law to monitor it. It is enough to look at one bacterium to see the scale of the problem. In an instant, one infected patient becomes 300. But the world is finally starting to see the problem.
Prof. Waleria Hryniewicz: Not completely. Only a certain part of it perceives the threat. Still outside medicine in animal husbandry in many countries of the world – antibiotics are used, which is absolutely unacceptable. The European Union keeps an eye on this, but in the United States, which has a great merit in bringing new drugs to the market, antibiotics are still used in breeding, despite protests by the most important public health institution, which is the CDC.
Should we be afraid of the meat we buy?
Prof. Waleria Hryniewicz: Not. Veterinary services in Poland and the entire European Union have appropriate powers and carry out controls, they make sure that everything is in the best order. However, we observe high resistance to antibiotics in typical zoonotic bacteria and infections caused by them, the so-called zoonoses are becoming more and more difficult to treat. This is what happened, for example, with salmonella and E. coli. Unfortunately, antibiotics have become victims of their own success. The 60-70s brought new drugs every now and then. It was believed that there would be something new in a moment and we would be able to deal with dangerous bacteria. Despite the warnings, the existence of the threat did not reach our awareness.
How can we defend ourselves?
Prof. Waleria Hryniewicz: There are now thousands of different offers. Research is being done on phages and the enzymes they produce. There is some hope here, but as of today we do not have any registered preparation.
Dr. Tomasz Ozorowski: What you are talking about are experiments. Hospitals are the habitat of these drug-resistant bacteria, so what we can successfully implement now is the prevention of nosocomial infections. By using such programs, facilities can reduce the number of infections by 70%. Second, they can implement procedures to reduce the transmission of infections between patients. Rapid detection, patient isolation, hand hygiene is what we can do to protect ourselves.
Prof. Waleria Hryniewicz: In addition to drugs, vaccines and compliance with the rules of hygiene in hospitals, very intensive work is underway on rapid diagnostics all over the world. It is very important that you find out as soon as possible what caused the infection and whether and what medication can be used. There is already a lot of progress here.
Dr. Tomasz Ozorowski: Genetic research is also developing rapidly.
Maybe it is in the genes that we will find salvation in the future. Will it be possible to program a person to become immune to infection?
Prof. Waleria Hryniewicz: The human genome is examined for susceptibility to infection. Some are more susceptible to a specific pathogen, others less. Rather, these tests should go towards prophylaxis, perhaps they will be helpful in situations where it will be necessary to quickly decide what treatment to apply.
Will we be dying of bacterial infections in thirty years and not of heart disease or cancer as we are now?
Prof. Waleria Hryniewicz: It all depends on the country. I recently read an article in the New York Times, “What Are We Going To Die For?” And it showed how much deaths from heart disease have been reduced. In this case, we see a decline practically everywhere. Cancer has also shaken up in the United States, there is a significant decline, and I think we are now entering a period when new drugs for various forms of cancer are appearing very intensively. When it comes to infections, we have little to offer. It will be the problem of the future. There is talk of a rapid increase in the number of diabetics, yet diabetics are more susceptible to infections.
Dr. Tomasz Ozorowski: It is indeed strange that infectious disease is the only area of medicine where we are not making progress. On the contrary.
Why is this happening?
Dr. Tomasz Ozorowski: Due to drug resistance.
Prof. Waleria Hryniewicz: And sleep the right moment to act.
So we missed a moment?
Prof. Waleria Hryniewicz: I think that we were so eclipsed by the successes of the 60-70s and there was always something new that we stopped taking care of them.
Will pathogens that have not been found in Europe reach us due to climate change and warming?
Prof. Waleria Hryniewicz: Definitely. We already have more ticks and hence more cases of Lyme disease. Due to global warming, we are at risk of malaria.
Dr. Tomasz Ozorowski: But “more dangerous” is the intense movement of people and goods.
Prof. Waleria Hryniewicz: We travel a lot around the world. We transport goods from all over the world and this is a factor that we will not eliminate. We obtain new pathogens during our travels and bring them here.
What about terrorists? Will they start using bacteria instead of shahid belts?
Prof. Waleria Hryniewicz: Bioweapons have been known for a very long time, and the not-so-old example of the United States and anthrax shows that anything is possible. Much depends on what part of the world we are in. There are many threats, and they threaten us everywhere and with everything.
But isn’t that more tempting and simpler?
Prof. Waleria Hryniewicz: Not completely. Certain microbial characteristics must be met and must be expressed. Certainly there are viruses and bacteria that fulfill all the qualities of a biological weapon, but hopefully they are under control.
There is a lot of talk about smog and air pollution. Could it happen that we live to the time when we will not be able to leave the house without, for example, a special mask?
Prof. Waleria Hryniewicz: Something might be up. Mucosal damage promotes infections. Research from the 80s of the National Institute of Hygiene in Krakow showed that local residents were more susceptible to upper respiratory tract infections due to poor air quality, and this in some ways may favor antibiotic resistance, as we will have to treat and heal.
What will microbiology look like in thirty years?
Prof. Waleria Hryniewicz: The microbes will feel great.
Dr. Tomasz Ozorowski: I think diagnostics will go a long way. We will know what we are dealing with very quickly. When it comes to hospitals, everything will be aimed at hospitalizing patients in separate rooms and separating them from each other. As for antibiotics, the vision is not optimistic.
Prof. Waleria Hryniewicz: Unfortunately, as of today, there is no groundbreaking study or event. The work on vaccines will probably continue, but it is not that simple, the research will certainly go in different directions. I think vaccines are a very good direction and one of the best things that has happened to humanity.
Will viruses and fungi be equally dangerous in the future? What will we fear the most?
Dr. Tomasz Ozorowski: They are already here. Let’s take the flu, for example, which we also cannot cope with completely. Although we have the drug, it must be administered immediately. What’s worse, it’s not quite effective.
Prof. Waleria Hryniewicz: I think that the greatest threat, however, will be zoonotic infections, which are usually viral, as shown by the SARS and MERS epidemics, but also influenza and Ebola.
Prof. Waleria Hryniewicz is a national microbiology consultant, an employee of the Central Center for Quality Research in Microbiological Diagnostics of the National Medicines Institute.
Dr. Tomasz Ozorowski is a microbiologist, expert of the National Antibiotic Protection Program, chairman of the Section for the Control of Hospital Infections at the Clinical Hospital of the Transfiguration of the Medical University in Poznań and president of the Association of Hospital Epidemiology.