The vision of the post-antibiotic era is not a fantasy but a real threat in the XNUMXst century. It is one of the primary dangers to public health in the world.
Last year, the World Health Organization announced that the 50st century could become a post-antibiotic era. Even mild infections will cause death. In the face of some bacteria, we are already defenseless and helpless. When penicillin was introduced, the phenomenon of resistance was known. In the mid-50s, more than 1959 percent. golden staphylococci was resistant to this antibiotic. Methicillin, introduced in 2, had its first resistant strain two years later.
Carbapenems were drugs of last resort in the 80s. For a short time. Because in the next decade, carbapenemases appeared – enzymes resistant to these antibiotics. Antibiotic resistance got out of control just then – in the 90s the rate of emergence and spread of resistant bacteria significantly exceeded the rate of introducing new therapeutics. For pathogens resistant to at least 3 groups of antibiotics, the so-called MDR, microbiologists had to add two new categories – extremely resistant XDR, sensitive to only one therapeutic group, and PDR – resistant to all available antibiotics.
We already have a very high percentage of multi-resistant bacteria. For example, in 2010, the percentage of Escherichia coli strains that “ignored” antibiotics was over 57 percent! Therefore, in 2014, the WHO announced that the 80st century could become the post-antibiotic era. Even mild infections will cause death. According to this organization, hospital infections with multiresistant MDR microorganisms cause deaths annually: 30 in China, 25 thousand in Thailand, 23 thousand. in Europe, 2 thousand in Usa. This is the tip of the iceberg, because only confirmed cases. In the United States, XNUMX million people are affected by antibiotic-resistant bacteria each year.
– The vision of the post-antibiotic era is not some apocalyptic fantasy, but a real image of the XNUMXst century – emphasizes prof. Waleria Hryniewicz, medical microbiologist from the National Medicines Institute, head of the National Antibiotic Protection Program (NPOA). In the latest report prepared as part of the Program, we read, inter alia: “Antibiotic resistance has become one of the main threats to public health in the world.” Such a great threat as catastrophic floods, huge volcanic eruptions or terrorists. Or even bigger. Because none of these problems generate that many casualties each year.
Tyralier
Never before have countries in the world been as unanimous as in May 2015 at the World Health Assembly, when 194 countries unanimously agreed that the problem of antibiotic resistance is very important for the Earth. And it must be counteracted globally.
The European Center for Infection Prevention and Control (ECDC), the European Commission and the American Center for Infection Prevention and Control (CDC) have been sounding the alarm for a long time. In 2009, at the European Union-USA summit, TATFAR – the Transatlantic Group on Antibiotic Resistance of Microbes was established. The White House has also created its special team to fight this threat.
WHO, in its latest report, warns: the problem of antibiotic resistance is so serious that it threatens the achievements of modern medicine. The organization emphasizes: not only the public, but also doctors and nurses have insufficient knowledge about antibiotic resistance. Meanwhile, only a quarter of countries in the world have their own programs to combat this problem.
Therefore, between 16 and 22 November, WHO is organizing, for the first time in history, the World Antibiotic Awareness Week. So far, similar types of actions have been carried out only in Europe.
Easy
The causes of antibiotic resistance are known. Especially in the medical community. Theoretically. Because it is here that they are most often neglected. Most compelling cause: overuse of antibiotics. In Poland, as much as 70 percent. patients with upper respiratory tract infection receive antibiotics from their doctor, mainly primary health care. Meanwhile, only 15 percent. there are indications for this. In the rest of the cases, we deal with viral infections – e.g. influenza or bronchitis. Doctors forget that, for example, until the age of 3, children practically do not have streptococcal tonsillitis, and almost never in people over 45. In the case of simple surgical interventions, antibiotics are also administered too often. When cutting e.g. a boil, it makes sense if it is e.g. on the face.
– Doctors also often treat carriers of bacteria with antibiotics. This is not done – emphasizes prof. Hryniewicz.
Patients add their pennies – most often they do not take the entire dose of these drugs (20%), or they do it at the wrong time intervals. Recently, they can buy antibiotics without a prescription.
– We are probably the only country in Europe where furazidine can be obtained without a doctor’s recommendation – says prof. Hryniewicz. She has already written letters of protest in this matter to “all saints” in the Ministry of Health. Unsuccessfully. Due to this abuse, the average Pole consumes an average of 23–24 daily doses of antibiotics per year. So 4 full therapies! The problem is also the administration of antibiotics to animals intended for consumption – this is already a pathology. These drugs also end up in their feed / food. Even for fish ponds. Orchards and vegetables are also sprayed with them. In the US, the livestock lobby is struggling very hard to maintain these opportunities. Only one state has forbidden it. Therapy-resistant bacteria can already be found in wild animals, birds, soil and even puddles. Thanks to human travel, resistant strains of bacteria move quickly. For this reason, in Poland, Warsaw is the most vulnerable to problems with multi-resistant bacteria.
Exemplary
Antibiotic resistance is best controlled in Scandinavia and the Netherlands. – There is actually no problem there – believes prof. Hryniewicz. The percentage of MRSA – methicillin-resistant staphylococcus in Hong Kong is as high as 80 percent, in Japan – 74 percent, in Singapore 63 percent, and in Scandinavia and the Netherlands below 1 percent! How do they do it? There, the essence of the problem was understood very early. Each country has been running a national strategy for many years. Sanitary supervision systems over health facilities are well organized. – But cultural considerations are of key importance here – believes prof. Marek Gniadkowski, molecular biologist at the National Medicines Institute.
The Scandinavians are more disciplined nations than, for example, the societies of southern Europe. They care more about hygiene, especially in hospitals. Doctors have better diagnostics. Fast, and when it comes to the throat, it’s almost instant. Therefore, they do not prescribe antibiotics when there are no indications. They also have overdue prescriptions. The doctor issues it and keeps in touch with the patient. If his condition worsens, then the doctor recommends that he get his prescription filled.
– I cannot imagine introducing anything like that with us. Because the patient would buy these antibiotics right away – believes prof. Hryniewicz. Scandinavia also has much more funds to fight antibiotic resistance. Until recently, the opposite of these countries was the UK. Britain. In 2009, the percentage of methicillin-resistant Staphylococcus aureus (MRSA) strains exceeded 50 percent. Then the counteroffensive started. Extremely intense. The health service, the media and the authorities launched a massive action against antibiotic resistance. Every case of MRSA had to be reported.
– And almost everyone was publicized in the media. The press played the most important role in this fight – claims prof. Hryniewicz. In 3 years, the percentage of MRSA has dropped by more than half – less than 25 percent!
Medium kids
On the EU antibiotic resistance maps, we are usually somewhere in the middle of the scale – we are far from the worst-off countries (Greece, Italy, Cyprus, Romania, often Slovakia and Portugal), but there is an even greater distance from the above-mentioned countries. leaders in this fight. Although not always – in 2013, the percentage of Streptococcus pneumoniae strains resistant to penicillin was among … the highest in Europe! While in 2009 in Poland, 20 percent. Staphylococcus aureus bacteria were resistant to methicillin, 3 years later this percentage had already increased to 29 percent.
The first case of NDM – enzymes of the bacterium Klebsiella pneumoniae resistant to antibiotics – was discovered in Poland in 2011. A year later, 4 cases were detected, in 2014 – already 249, and in the first half of 2015 – 221! – Growth is shocking – emphasizes prof. Gniadkowski. The problem of resistance in Poland is growing. It’s commonplace in hospitals. Meanwhile, the existing National Antibiotic Protection Program has funds secured … until the end of 2015. What’s next? It is not known.
– There is no decision on extending the program for the following years – says its boss in mid-October this year. Annually, the Ministry of Health spent PLN 1,5 million on the NPOA. Out of this, on recommendations for doctors, their training was only 500-600 thousand. – We have too little money for our activities – admits prof. Hryniewicz.
Meanwhile, the costs of reimbursement of prescribed antibiotics reach over PLN 80 billion a year. Taking into account the estimates that approx. 800 percent. these drugs are prescribed incorrectly, the money thrown down the drain from the state coffers would reach over PLN 75 million. It is difficult to say how much money for the same reason patients are losing. How high is the cost of antibiotic resistance in Poland, taking into account all its effects? No such data. Certainly, these sums are many times greater than what the National Health Fund throws away. So the expenses for NPOA would be a per mille compared to the costs incurred by Poland. In the USA, the cost of antibiotic resistance is estimated at approx. PLN XNUMX billion annually.
What are pneumococci and are they dangerous for my child – see the episode “Time for health”
To improve
The head of the NPOA sees a whole range of actions necessary in Poland to reduce the problem of antibiotic resistance.
- Training courses in antibiotics in each specialization. – Only ophthalmologists have a week of internship in the microbiological laboratory – says prof. Hryniewicz.
- Including this topic also in postgraduate training. Every 3 years obligatory. – Because drugs, therapies and recommendations are changing – explains the head of the NPOA.
- Dissemination of cheap, quick tests in clinics, which would allow the doctor to determine immediately whether he is dealing with a virus or a bacterial infection. Prof. Hryniewicz talks about the offer that the NFZ received – the purchase of 3 million such streptococcal tests. Thanks to them, the doctor would know in no time whether to prescribe penicillin for pharyngitis. Cost: PLN 1,2-1,7 per item. The National Health Fund was to refuse the purchase, explaining that there was no legal possibility to do so.
- Introducing better prescription control. How? – Doctors would have to enter the reason for administering the antibiotic, it would be verified whether the ordinance is consistent with the recommendations based on EBM – explains Prof. Hryniewicz.
- Extending specialization training for candidates for heads of epidemiological teams. – In Germany it takes 5 years, in Poland it is enough … 6 days – says the professor.
Too modest funds of the Program mean that its employees try to carry out as many actions as possible … without money. Trams in Szczecin and Gdańsk only want a symbolic zloty for putting up posters on antibiotic resistance in them. Public media very rarely broadcast a short spot on this problem free of charge. – If anything, then on regional TV stations – adds prof. Hryniewicz. The employees of the program “carols” in other media. – Write about it as much as possible, because it is up to you, journalists, what most depends on now – appeals prof. Hryniewicz at a conference in the Polish branch of WHO.
– We are in a rather dangerous moment – emphasizes prof. Gniadkowski. – At the wall. Because the process of spreading resistance is accelerating. And we have fewer and fewer effective drugs – warns prof. Hryniewicz. And less and less time to react. Firm and proper.
Based on: “Służba Zdrowia” 11/2015