Jan 28, 2021
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Resistant microorganisms. Why does antibiotic resistance develop?

Antibacterial resistance is the number one issue today. Indeed, against the background of the appearance of microorganisms that do not respond to drugs known and proven for years earlier, there are risks of problems with therapy. Why organisms lose susceptibility to drugs, and how to deal with it, told Igor Chebotar, MD, DSc, Head of the Laboratory of Molecular Biology, Russian National Research Medical University named after N.I. Pirogova

Global problem

“The spread of antibiotic-resistant bacteria has reached global proportions. Most hospital strains of leading opportunistic bacteria (Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. And others) show signs of resistance to beta-lactams, fluoroquinolones,. In practice, this means that many antibiotics are no longer useful for treating diseases caused by infectious agents, ”says Igor Chebotar.

Against the background of all this, today more and more news about superbugs appears, as well as fungi that are resistant to therapy and known drugs. It often turns out that a standard pathology, which is traditionally well treated with antibiotics, suddenly turns into a deadly and uncontrollable one.

Why is there a problem?

According to Igor Chebotar, there are two main reasons for the development of antibiotic resistance. “The first is associated with the natural ability of bacteria to very quickly and flexibly rebuild their metabolism to survive under antibiotic therapy. Our experiments have shown that Pseudomonas aeruginosa (Pseudomonas aeruginosa) adapts to concentrations of meropenem (and this is one of the last and most effective beta-lactam antibiotics) in 13 days, which are 1000 times higher than therapeutic concentrations, ”the specialist notes.

Igor Chebotar calls the second reason “medical”. “The basis for the evolution of antibiotic resistance is due to the misuse of antibiotics, which is caused by subjective and objective reasons,” the expert emphasizes.

Igor Chebotar refers to the subjective reasons for the development of antibiotic resistance:

  • self-medication;
  • non-compliance with the doctor’s recommendations and other factors.

He calls objective:

  • low quality of some antibacterial drugs;
  • contradictions in recommendations;
  • lack of active antibiotic restriction programs.

“However, the spread of antibiotic resistance is associated not only with the use of antimicrobial drugs in medical practice. It is necessary to pay attention to the fact of the growing consumption of antimicrobial agents in non-medical spheres of human activity – agriculture and the food industry – which is a new and underestimated threat, ”the specialist notes.

The volume of antibiotics consumed in agriculture, Igor Chebotar notes, reaches enormous proportions. In 2010, the expert cites statistics, 63151 ± 1560 tons of antimicrobial drugs were used in agriculture, which corresponds to hundreds of billions of therapeutic doses for humans. “According to experts’ forecasts, this value will double by 2030 and will amount to about 105.596 ± 3.605 tons (Van Boeckel, et al., 2015). If we compare this with the data of Klein E. et al. (2018), it can be argued that the mass of antibiotics used in agriculture is ten times greater than the mass of antibiotics used to treat humans. The consumption of antibiotics in agriculture in the BRICS countries, namely in Russia, Brazil, India, China, South Africa, is expected to double by 2030, ”the expert notes.

The results of such antimicrobial intervention, says Igor Chebotar, cannot but lead to the progression of antibiotic resistance in bacterial isolates from animals and agricultural biotopes. “Already now, enterobacteria are isolated from the facilities of some agricultural enterprises, more than 30% of which are resistant to antibiotics. In such a situation, one should remember about the constant transfer of resistant pathogens from agricultural objects to humans, ”emphasizes Igor Chebotar.

The transfer is carried out due to:

  • direct contact of agricultural workers with contaminated materials and animals,
  • through agricultural products that end up on the consumer’s table,
  • through waste (waste water, aerosols, dust, etc.) entering the environment.

Thus, the specialist says, the two main drivers of the spread of resistance – medical and agricultural – are progressively returning the therapy of infectious diseases to the state in which it was at the beginning of the twentieth century before the discovery of antibiotics. In other words, even a banal bacterial pneumonia caused by a pan-resistant strain will become a deadly disease.

What to do?

And here it is worth taking action in time. “The most real and effective way is organizational measures aimed at limiting the use of antibiotics. Algorithms for restricting the use of antibiotics used in Western Europe, the USA and even in Belarus have already shown their effectiveness, ”says Igor Chebotar. So there are options. The main thing is to correctly use the existing developments.

There are contraindications, specialist advice is required

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