Antibiotic-resistant bacteria scare the planet. The deaths from this cause already number in the hundreds of thousands around the globe—1.2 million each year, according to one study—and the scientific community is accelerating the search for new tools to overcome its impact before it is too late. From the front line of battle, microbiologist Bruno González-Zorn, director of the Antimicrobial Resistance Unit of the Complutense University of Madrid and advisor to the World Health Organization (WHO) in this field, is optimistic: after years “preaching in the desert”, alone and without much attention from the institutions, he has managed to convince the actors involved and has seen progress, such as the implementation of a national plan to combat resistance or greater citizen awareness, he says. “This makes me think that in the coming years we will make more progress, there will be better prevention plans in hospitals, more awareness among the population, more optimized consumption and some preventive or treatment molecule that will help us more,” predicts the scientist, who attends EL PAÍS after his participation in the Update Conference on the Antimicrobial Use Optimization Program organized by the Mutua de Terrassa Hospital a few days ago.
Despite the enthusiasm and hope, González-Zorn (Madrid, 52 years old) admits that there is still work to do and accelerate the pace. The researcher does not look at anyone and he looks at everyone. He refuses to point fingers. “We are all co-responsible. The key is joint cooperation without pointing fingers at each other,” he says.
Ask. A study warns that multi-resistant bacteria kill 20 times more than traffic accidents in Spain. More than 23,000 deaths in 2023.
Answer. We are beginning to give a name and voice to all those anonymous patients who die in hospitals due to antibiotic resistance. We constantly have deaths in all the hospitals in Spain that no one talks about. And they die because the latest generation antibiotics that we are giving them no longer work. This problem is spectacular, we already know it. What we need is for the population to know that it is not trivial to take amoxicillin at home [sin prescripción médica]: that prepares the bacteria to resist that antibiotic of last resort that only hospitals have and that in the end ends up not working.
Q. Are you surprised by the figure of 23,000 deaths?
R. It doesn’t surprise us at all. We have known this topic deeply for many years. What we like is that it leaves the strictly scientific field and that the population is aware that, just as they put on a belt, they cannot self-medicate, they cannot keep an antibiotic in case they use it at another time. We need zero pharmacies to give antibiotics without a prescription, but in Spain it is still 5%. And, although it may not seem like much to you, that 5% does a lot of damage to the other 95% because citizens realize that, by going from one pharmacy to another, they end up getting it without a prescription and that trivializes the antibiotic.
Q. Is the antibiotic trivialized?
R. The antibiotic is trivialized in Spain. And in the end it is associated that, just as I have paracetamol, I have amoxicillin in my medicine cabinet and, from time to time, I use it. That can not be. We must act against those 5% of pharmacies, against the person who self-medicates, against the professional who prescribes too much or according to the eighties…
We need zero pharmacies to give antibiotics without a prescription, but in Spain it is still 5%”
Q. Who suffers from these resistances? What is the patient profile?
R. It is important to know that, even if you do not take antibiotics, the bacteria that live in hospitals, for example, which are more resistant to antibiotics, are the ones that affect you. You may be a young and wonderful person, but when you go to the hospital, you are affected by the bacteria that has already been living in the intensive care unit (ICU) for a long time and is resistant to all antibiotics. The profile is of a person who arrives and, after surgery, for example, the post-surgical infection, which is normal in all hospitals in the world, becomes so complicated that it ends up killing the patient.
Q. Is the era of antibiotics coming to an end?
R. We are beginning to enter a post-antibiotic era because mortality is increasing from diseases that we previously controlled. We have more and more pan-resistant bacteria: before we talked about bacteria that resist many antibiotics and now we talk about pan-resistant bacteria, which resist them all. Five years ago, we only had these in a few places in the world, such as India or China; Now, in practically all Spanish hospitals we have pan-resistant bacteria to antibiotics. It is advancing and it worries us a lot. At some point we are going to have a bacteria that transmits very well, that is very resistant to antibiotics, and then we will be alarmed. That is going to happen and we have been warning for a long time, so we need many people to take important treatment and prevention measures.
Q. Will we be able to see that you die, for example, from an injury you get when you fall in the street?
R. We are already seeing it. We are already seeing urinary infections that become complicated and, when before they responded well to antibiotic treatment, now the patient is dying because they are not cured with antibiotics.
Q. Has a point of no return been reached or by taking measures could we go back to that antibiotic era again?
R. The topic is complex. There are some bacteria that, when they are no longer subjected to the antibiotic, become susceptible very quickly and very easily. So, in some cases, the rollback is very fast and effective. For example: colistin is an antibiotic of last resort in hospitals, which has been widely used in animals, but in that context we have gone from a very high use in Spain to practically zero, and the bacteria have immediately become sensitized to colistin. But there are other resistances in which it will be more difficult to regain that susceptibility: for example, with resistance to carbapenems or third-generation cephalosporins, we are seeing that bacteria appear that are very happy with the resistance even if the antibiotic is not present.
Q. Bacteria, for survival, will always try to continue resisting antibiotics. Is this an indefinite war?
R. It is indefinite. Bacteria are the most common living being on earth. Antibiotics have done a lot of good, but effectively, if you stop developing new antibiotics – and we have not discovered a new family of antibiotics for 30 years – and only use those old weapons, bacteria become resistant. We need new families of antibiotics and as we develop them, we need new vaccines and new strategies to fight bacteria.
Q. In a television program in which he participated while traveling to India, they managed to buy carbapanema without a prescription in a pharmacy, which is one of the antibiotics of last resort, used when nothing else works. What do you do when this is happening and we live in a globalized world?
R. We have to fight against it. In the end, resistance in each country depends on the antibiotics used in the country. It’s not that everything only comes from outside, everything colonizes our ecosystems and we are lost. National and local action is essential. The Dutch go to India ten times more than we do and have much fewer of these bacteria. We have a direct relationship between antibiotic consumption in a country and resistance: even if they travel, bacteria colonize when that antibiotic is present and if not, they lose that resistance.
Q. What impact did the pandemic have on the fight against antimicrobial resistance?
R. In the short term it has had a huge impact. Due to Covid, antibiotic-resistant bacteria have appeared that we did not expect to have until 2030. Many respiratory viruses open the door to secondary bacterial infections and, at the beginning, with Covid, they began to be treated with antibiotics. But, we quickly realized that Covid patients were not dying from a secondary bacterial infection, but from the famous cytokine storm, so patients began to be treated with corticosteroids instead of antibiotics. In the rest of the countries of the world, the population in ICUs increased, these units were overused beyond what they could, there were more hospital-acquired infections and more consumption of antibiotics. The pandemic has enormously accelerated resistance to antibiotics, to the point that I say the 10 million deaths that were expected in 2050 due to this, we are going to have in 2040 because there has been an enormous acceleration of generation of bacteria resistant to last resort antibiotics.
Due to covid, bacteria resistant to antibiotics have appeared that we did not expect to have until the year 2030″
Q. Another variable that influences resistance is wars. There are now several active armed conflicts around us. How will this affect?
R. We know it is affecting us. Patients from Ukraine have already appeared with pan-resistant bacteria that were not in our region. Because? Because in conflict zones, there is what we can practically call a perfect storm for the generation of resistant bacteria: there is no system for diagnosing diseases, there are a large number of open wounds that become contaminated with many different types of bacteria. , broad-spectrum antibiotics are needed en masse where you don’t even have access to antibiotics and you give whatever you have… And this whole cocktail accelerates the formation of antibiotic-resistant bacteria exponentially.
Q. To combat the phenomenon of resistance they are attacking on several fronts. But he said that there has not been a new family of antibiotics available for more than 30 years. Isn’t the pharmaceutical industry interested?
R. The economic model of antibiotic development is broken. Right now there is no pharmaceutical industry with more than 500 workers in the world that is developing an antibiotic. They have abandoned it because it is not profitable. Lack of economic incentive. We are developing the prize model, which is now being discussed in the European Union: whoever brings an antibiotic to the market, I am going to give an economic prize, 300 million euros, for example, which we have put together all the countries, because we need an antibiotic against these bacteria. Or we extend a patent for any molecule they have in their portfolio.
Q. At a therapeutic level, one of the ongoing investigations is the use of bacteriophage viruses, phages, to annihilate resistant bacteria. What are the most promising lines?
R. Phages have a way out, but you have 100 times more payments to your intestine than bacteria and there are mechanisms of resistance of bacteria to phages. So phages are one possibility, but there are many others. For example, nanotechnology techniques so that molecules can detect where the infection is and release a more concentrated antibiotic. Artificial intelligence is helping us a lot to know how an antibiotic is going to behave and how to treat it individually. We could also develop bacteria that introduce [la técnica de edición genética] CRISPR, which ideally would be able to inoculate a CRISPR system into pathogenic bacteria so that their DNA is digested and they die. There are many very original strategies, many for intestinal health and prevention. For example, intestinal health control and probiotics and prebiotics: bacteria that colonize an ecosystem where antibiotic-resistant bacteria cannot colonize.
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