Why humans are losing the race against superbugs

Drug-resistant bacteria – also known as superbugs – are on the rise globally, and they are now killing more people each year than HIV/AIDS or malaria. And low- and middle-income countries are being hit hardest by the rise in antibiotic-resistant infections.

“That resistance is actually now one of the leading causes of death in the world,” says Dr. Chris Murray, director of the Institute for Health Metrics and Evaluation. Murray is one of the authors of a new study published in the medical journal the Lancet, which found that in 2019, drug-resistant infections directly killed 1.2 million people and played a role in 5 million more deaths worldwide. Murray and his colleagues set out to determine how much of a global antibiotic resistance is a problem, and they found that bacteria are turning to antibiotics at a rate much faster than many researchers previously anticipated. Was.

These deadly new strains of bacteria are causing untreated blood infections, fatal pneumonia, persistent urinary tract infections, gangrenous lesions and terminal cases of sepsis, among other conditions.

There used to be conventional wisdom that the failure of antibiotics was a “first world” problem. But Murray says this new study shows it is happening all over the world.

“In the past, we all thought you had to be rich enough to use a lot of antibiotics inappropriately for this problem,” he says. “but it’s not like that.”

Researchers have calculated that direct antibiotic resistance deaths are highest in sub-Saharan Africa, causing 24 deaths per 100,000 population in high-income countries, compared to an average death rate of 13 per 100,000. Australia has one of the lowest mortality rates from antibiotic resistance globally, 6 deaths per 100,000.

Latin America is right in the middle. But Fiorella Crapp Lopez, an infectious disease doctor in Lima, Peru, says living in the middle is still bad enough.

“We have a very high frequency of resistance to different types of antibiotics, first-line and second-line [antibiotics], ” says Krapp. “And the problem has been increasing over the years.”

She says antibiotic resistance is affecting every level of health care in Peru.

“Unfortunately, I think it’s everywhere. We’re seeing it in the community with infections that were very easy to treat, like urinary infections,” she says. Physicians are seeing minor wounds that previously may only require a bandage but are now turning into multi-drug-resistant infections. “And we also see it in very ill patients with bloodstream infections or very severe pneumonia. Unfortunately, it is in the full spectrum of bacterial infectious diseases in Peru right now,” she says.

Krapp was one of dozens of researchers from around the world who contributed to the new Knife report good. She specifically provided data on drug resistance in Peru.

She says there are many reasons why this problem is difficult to address in low- and middle-income countries.

First, antibiotics are often readily available to anyone without a prescription. Abuse and overuse of these drugs promote mutations in bacteria, leading to greater resistance.

Second, systems to flag and test for potentially drug-resistant infections are not as robust as in some wealthy countries.

Third, low- and middle-income countries generally report higher rates of infection in hospitals than high-income countries, and those infections are more likely to be drug-resistant.

Fourth, while some newer, more potent antibiotics are being developed, low-income countries still rely on older, cheaper, less effective drugs.

Crapp says the COVID-19 crisis has exacerbated all these problems in Peru. And while it’s too early to tell, he worries that the coronavirus pandemic has led to a significant increase in drug resistance.

“First, there was a lot of antibiotic use during the pandemic,” she says. As the COVID-19 crisis engulfed Peru, many people who contracted the virus didn’t want to go anywhere near overcrowded hospitals, so they self-medicated at home.

“It’s still very easy to get antibiotics at a local pharmacy without a prescription,” Krap notes. “Unfortunately, over 70, 80% [COVID-19] The patients who reached the hospital were already using antibiotics at home.”

He believed that medicines would help him in his recovery. But antibiotics target bacteria and won’t help much against the coronavirus.

This scenario may be one reason why Peru has the highest per capita death rate from COVID-19. At times, hospitals and clinics were barely able to function because they were overcrowded with patients.

“We believe that the very high COVID mortality rate we had in Peru was due to secondary infections acquired in hospitals, rather than COVID-19,” Krap says.

Whether this happened or not is difficult to say. Surveillance of antibacterial resistance in Peru – and in many other low-income countries – is limited during the best of times, but is particularly unlikely when hospitals are filling up with COVID-19 patients.

“During the pandemic, hospitals were overloaded. A lot of patients went into ICUs, which were short of staff. It was the perfect storm for a very high transmission. [drug-resistant] pathogenic,” she says.

It is unclear if this was happening because health care workers were only trying to breathe in COVID-19 patients, with testing bacterial samples for resistance dropped low on the priority list.

Krapp says that overall he is very concerned that bacteria are evolving and learning how to avoid some of the world’s most powerful drugs.

“We are in a race, and these bacteria are moving faster than we are,” she says. “They are becoming resistant much faster than we humans, we are able to create new antibiotics and make those antibiotics accessible to the most vulnerable populations.”

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