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The invention and popularization of antibiotics allowed us to overcome many dangerous infectious diseases. Now the biggest challenge is the phenomenon of increasing antibiotic resistance of bacteria, and the scale of this phenomenon is enormous. According to estimates, 25 die every year due to infections caused by antibiotic-resistant bacteria in European Union countries. people. No wonder that this year’s World Health Day will be devoted to the spread of more and more bacteria resistant to antibiotic treatment. After all, it is a very serious threat to public health.
Irrational antibiotic therapy
One of the main reasons for the growing antibiotic resistance of bacteria is the abuse and misuse of antibiotics. The European Surveillance of Antibiotic Consumption, the European program for monitoring the consumption of antibiotics, shows that Poland occupies one of the leading places in Europe in this respect. This is also confirmed by the research conducted in October 2009 by MillwardBrown SMG / KRC at the request of the National Medicines Institute. In the last 12 months before they were carried out, 37% admitted to taking antibiotics. adult Poles, and in the last two years – 57 percent! It turns out that we treat viral infections with antibiotics in which they are ineffective, e.g. a cold (30% of respondents’ answers), a sore throat (24%), flu (16%), cough (12%). Almost 60 percent of respondents believed that antibiotics kill viruses!
On the one hand, the low level of knowledge of patients about antibiotics is striking, on the other – the lack of professionalism on the part of doctors who regularly prescribe antibiotics to patients with viral upper respiratory tract infection. Why are they doing this? Because they do not collect a culture material from them or collect it after the start of antibiotic therapy, when the test result may no longer show the presence of the living microorganism causing the infection. It also happens that when collecting material for research, numerous mistakes are made, resulting in inappropriate antibiotic therapy. This is because – as prof. Waleria Hryniewicz, president of the Polish Society of Microbiologists and national consultant in the field of medical microbiology – doctors are not very interested in nosocomial infections, antibiotic therapy, vaccinology and prophylaxis. Undergraduate and postgraduate education in this area is insufficient, and the interest in the specialization in medical microbiology is close to zero. – Every year, only two people take the exam, and we need at least seven hundred – says prof. Waleria Hryniewicz.
A few years ago, as part of the National Antibiotic Protection Program, a program of rationalization of antibiotic therapy in primary care was developed in Poland. It puts emphasis on educating the doctors working in it and raising the awareness of patients and parents of children about the legitimacy of using antibiotics. The program brought the best results in the Opolskie Voivodeship, where within 2 years – from 2007 to 2009 – the use of antibiotics among children up to 7 years old decreased by 16%. For the Opole region, this means that 22,5 thousand. patients did not use an antibiotic.
The most dangerous strains of bacteria
The most dangerous hospital pathogens are currently methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), multi-drug resistant Pseudomonas aeruginosa and Acinetobacter sp. , KPC).
– The most serious problem in the last two years in Poland has become the Klebsiella pneumoniae KPC + strains, which, apart from resistance to all beta-lactams, including carbapenems often called last-resort drugs, are also insensitive to many other groups of antibiotics. They are sensitive only to colistin and tigecycline, and sometimes to gentamicin or amikacin, but these drugs are of limited use, emphasize microbiologists.
Many hospitals in Poland are already struggling with the problem of Klebsiella pneumoniae KPC +. The centers are located in the Warsaw agglomeration, where an epidemic took place in 2009. In 98 percent. the hyperepidemic clone ST258 was responsible for it. 89 cases of infections have been confirmed. In 2010, others joined them. In total, over 200 cases of KPC + infections have been confirmed at the National Medicines Institute. In some hospitals, infections are repeated because, according to microbiologists, appropriate epidemiological measures have not been taken.
In the case of community-acquired pathogens, the most worrying phenomenon is the emergence of resistance to penicillin, macrolides among pneumococci (Streptococcus pneumoniae), the most common cause of acute otitis media and sinusitis, community-acquired pneumonia, meningitis and exacerbations in chronic obstructive pulmonary disease. and the so-called new fluoroquinolones. Increasing resistance of pneumococci to third-generation cephalosporins (ceftriaxone and cefotaxime), “last resort” antibiotics in the treatment of invasive infections, is also observed.
According to the data of the Polish Society of Microbiologists, 37 percent are already resistant to penicillin. pneumococci isolated from meningitis in children under 5 years of age. Third-generation drugs are also ineffective in every fifth of these cases.
26 international epidemic clones are responsible for the spread of pneumococcal antibiotic resistance. There are two Polish ones among them, fortunately they tend to disappear. The most famous Spanish clone ST156, serotype 9V, has a great influence on the increase of resistance, also in our country. – Mass vaccination of children up to 2000 years of age with a conjugated seven-valent vaccine, which confers immunity to serotypes 2, 4B, 6V, 9, 14C, 18F and 19F, was introduced in the United States in 23, and then in other countries. both the incidence of invasive pneumococcal disease and the level of antibiotic resistance, reminds Dr. Ewa Sadowy from the National Medicines Institute. At the same time, however, a fairly rapid increase in the level of non-vaccine serotypes was observed, e.g. serotype 1 associated with pleural abscess and severe forms of invasive pneumococcal disease and serotype 19A, characterized by high levels of antibiotic resistance.
And the opponent is getting stronger
Due to the very dynamically spreading mechanisms of drug resistance – both known and emerging – the fight against infections is becoming more and more difficult and more complicated. Pathogens isolated from infections in Poland show all types of resistance, i.e. to at least 3 therapeutic groups (MDR), to one therapeutic group (XDR), and to all available antibiotics (PDR, pandrug resistance).
Meanwhile, pharmaceutical companies are not interested in finding new molecules with antibacterial activity. Why? The answer is simple: they make four times less profit from selling them than from the sale of drugs used in chronic diseases. According to experts, over the past 20 years the number of new antibiotics registered in the United States has dropped more than fourfold. In addition, they are mostly modifications of old drugs that have been known for many years.
– We have less and less effective drugs with good effectiveness and safety parameters – alarms prof. Waleria Hryniewicz. – Resistance eliminates antibiotics with well-documented efficacy and safety from therapy, increasing the risk of failure and side effects, and increasing treatment costs.
Mariola Marklowska-Dzierżak interviewed
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