Infections, surgeries and ordinary medical practices have become life-or-death situations for many people, just as they were before 1928, when penicillin was discovered and antibiotics were born. These have saved the lives of millions of patients who previously died from simple bacterial pneumonia (in the 1930s it killed almost 40% of patients) or from the after-effects of a common infection. But over the years, bacteria have learned to defend themselves and resist the effects of antibiotics, to the point of becoming one of the 10 main threats to humanity, according to the World Health Organization (WHO). A projection published this Tuesday The Lancet from a Research conducted two years agoafter analysing 520 million data points, estimates that antimicrobial resistance (AMR) could kill more than 39 million people directly and 169 million indirectly (through association with other pathologies) in the next quarter century worldwide. The effect will be especially dramatic among those over 70 years of age, for whom the incidence will increase by 72% in high-income countries and 234% in North Africa and the Middle East.
“We are reaching the post-antibiotic era, when we will no longer have resources that work,” according to Luis Ostroskyhead of infectious diseases and epidemiology at UTHealth Houston (University of Texas Health Science Center), who was not involved in the study. “Medicine depends on the use of antibiotics for routine things like surgeries, therapies or transplants, and we are in a very dangerous time in history because antimicrobial resistance is increasing. In everyday medical practice we find infections that are not treatable with the antibiotics that exist now, and that is very serious,” he explains.
This post-antibiotic era began to leave its lethal evidence 30 years ago. Since then and until the beginning of the current decade, more than one million people (between 1.06 and 1.14 million) have died annually due to antimicrobial resistance, especially those over 70 years of age, an age from which cases of deaths due to this cause have increased by 80%, according to the new study by the Global Research Project on Antimicrobial Resistance (GRAM for its acronym in English).
If this trend continues, this figure will almost double by 2050, rising, according to the research, to 1.91 million direct deaths per year due to antimicrobial resistance, to which should be added deaths in which AMR plays an indirect role. Including these latter cases, deaths will increase by almost 75%, between 4.71 million and 8.22 million per year.
On the rise
“These findings highlight that antimicrobial resistance has been a major global health threat for decades and is on the rise. Understanding how trends in deaths from antimicrobial resistance have changed over time and how they are likely to change in the future is vital to making decisions that help save lives,” she said. Mohsen Naghaviauthor of the study and leader of the research team on RAM in the Institute for Health Metrics (IHME) at the University of Washington.
The study reflects a mixed trend: while it warns that the effects of AMR will be felt among those over 70 years of age, doubling the number of cases (72% more deaths in high-income countries and 234% in North Africa and the Middle East), on the contrary, it detects a reduction of more than 50% between 1990 and 2021 in deaths from the same cause among children under five years of age (from 488,000 to 193,000 direct deaths and from 2.29 million to 840,000 indirect deaths). This positive trend can be maintained among the youngest children due to improvements in the application of infection prevention and control measures.
“The decrease in deaths from sepsis [respuesta extrema del sistema inmunitario a una infección que lesiona tejidos y órganos] “The reduction in the incidence of AMR and antimicrobial resistance among young children over the past three decades is an incredible achievement. However, the findings show that while infections have become less common in young children, they have become more difficult to treat when they do occur. Furthermore, the threat of AMR to older people will only increase as the population ages. Now is the time to act to protect people around the world from the threat posed by AMR,” he says. Kevin Ikuta, PhD, University of California in Los Angeles (UCLA) and co-author of the study.
Regarding these actions that Ikuta is calling for and that could prevent 92 million deaths, Stein Emil Vollsetfrom the Norwegian Institute of Public Health and affiliated professor at IHME, details: “To prevent this [el pronóstico] becomes a deadly reality, we urgently need new strategies to reduce the risk of serious infections through vaccines, new drugs, better medical care, improved access to existing antibiotics and guidance on how to use them most effectively.
The importance of preventive measures is supported by the fact that the sustained upward trend in AMR temporarily decreased in 2021 due to social distancing and other disease control measures implemented during the COVID pandemic.
But the great hope is the discovery of new antibiotics because, Naghavi insists, “antimicrobial drugs are one of the cornerstones of modern health care and the increase in resistance to them is a major cause for concern.”
New antibiotics
For years, the Spaniard César de la Fuente, head of a laboratory that bears his name at the University of Pennsylvania, has been fighting for this battle to find new molecules with antibiotic capacity. He has found thousands of compounds in ancestors such as the Neanderthals, extinct animal species such as the mammoth, and even in our own digestive system.
De la Fuente agrees with the UN: “Antibiotic resistance is one of the greatest existential threats to humanity.” “According to this study,” he says in relation to the research of The Lancetin which it has not participated, “this crisis is already associated with millions of deaths each year, and it is estimated that by 2050, antibiotic-resistant infections could be associated with 8.22 million deaths annually if urgent measures are not taken. This alarming forecast underlines the immediate need to discover and develop new antibiotics, since bacteria are acquiring resistance to current treatments, putting global health at risk and exacerbating the health crisis.”
“In recent years, the use of artificial intelligence [IA] “It has significantly accelerated the process of discovering new antibiotics, reducing the time from years to just hours. I am convinced that AI can play a key role in solving this global health problem,” he explains.
The authors of the newly published forecast acknowledge some limitations in their study, such as the lack of data for some low- and middle-income countries, the limited information prior to the year 2000, and the fact that some of the 520 million individual records used to produce the estimates may contain errors or biases.
But Samuel Kariuki of the Kenya Medical Research Institute, who was not involved in the study, stresses that, regardless of the limitations, “it is important to assess changing trends and where AMR mortality is growing in order to understand how AMR is developing and provide evidence to inform decisions and drive targeted investment and action.”
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