The insidious threat of antimicrobial resistance
During my tenure as a communications advisor for the World Health Organization in Greece, despite the country being in the throes of the coronavirus pandemic and the relentless surge in cases, a long-standing issue continued to dominate our public health discussions for the international body.
This issue, one of the gravest threats to global health, is responsible for at least 700,000 deaths annually. Projections suggest it could cause 10 million deaths worldwide by 2050, surpassing the fatalities caused by cancer.
Interestingly, this issue is particularly pronounced in Greece, yet it often goes unnoticed. It is summed up in a familiar phrase many of us have uttered during a doctor’s visit: “Doctor, could you prescribe me some antibiotics?”
We are referring to the menace of microbial resistance, which is the escalating resistance of microorganisms to antimicrobials, rendering them less effective or even ineffective.
Resistant microbes, or superbugs, are created by the excessive and often indiscriminate use of antibiotics. These superbugs are not only immune to antibiotics but also survive and multiply unfettered, passing on their resistance to subsequent generations of microbes.
Today, in numerous countries worldwide, including Greece, countless patients are battling infections from bacteria resistant to almost all available antibiotics.
For this reason, many doctors, without any hyperbole, deem this phenomenon as the most significant long-term threat to public health. Humanity is already grappling with the risk of being unable to treat infections from common bacteria.
Today, in numerous countries worldwide, including Greece, countless patients are battling infections from bacteria resistant to almost all available antibiotics.
Of course, there are dozens of leading scientists diligently monitoring this phenomenon and steering public health policies to avert the worst-case scenario.
One such notable figure is Theocles Zaoutis, a professor of pediatrics at the National and Kapodistrian University of Athens, emeritus professor of epidemiology at the Perelman School of Medicine at the University of Pennsylvania and the Children’s Hospital of Philadelphia, and president of the EODY. LiFO had the opportunity to speak with him about the origins of this insidious public health threat and the strategies we have to combat it.
– Mr. Zaoutis, the issue of antimicrobial resistance has escalated to alarming levels worldwide, including in Greece. Could you explain, in layman’s terms, the factors that have led us to this point?
Certainly. The extensive and indiscriminate use of antibiotics is one of the most significant contributors to this issue. Simply put, the more microbes are exposed to antibiotics, the more they evolve to resist them.
The primary goal of a microbe is survival, which is why it continuously mutates, altering its genetic material to combat antibiotics. So, the more we use antibiotics, the more we fuel the development of antimicrobial resistance.
However, we can’t overlook the necessity of antibiotics. They are crucial for treating many infections and, ultimately, for saving human lives.
But the reality is undeniable: a considerable percentage of antibiotic use – some studies suggest as much as 50% – is entirely unnecessary.
For instance, doctors often prescribe antibiotics to treat viruses, even though they’re ineffective, either because the patient requests it or to reassure a worried parent.
By doing so, we’re encouraging germs to become increasingly robust and resistant. That’s why countries like ours, which consume a significantly larger amount of antibiotics compared to the rest of the EU, have some of the highest resistance rates.
A secondary, but crucial factor is the use of antibiotics in livestock. Across the globe, antibiotics are used in vast quantities in animal feed to promote weight gain and tenderize the meat.
This massive consumption of antibiotics “forces” microbes to evolve and resist daily. And it’s important to remember that microbes from animals can ultimately impact human health, as the health of our planet, animals, and humans are interconnected.
– The World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) have issued numerous dire predictions regarding the progression of antimicrobial resistance. How is resistance monitored and quantified? How is data collected and these forecasts generated? Where does Greece stand in all this?
The EU has a network within the ECDC where all member states submit an annual report. This report provides data on the microbial profile in our hospitals and the usage of antibiotics.
This information is available on the ECDC website. An interactive map of Europe displays the various microbes and levels of resistance. The data reveals the percentages and rankings of countries, forming the basis for models that examine the trend in microbial resistance development, as well as antibiotic prescription trends.
In a recent study assessing the impact of antibiotic-resistant infections, Greece ranked second in the EU on the “disability-adjusted life year” (DALY) index. This index measures the total number of healthy life years lost due to illness, disability, and death. In other words, Greece is second only to Italy in terms of the cost of antimicrobial resistance in human lives, and the situation is deteriorating.
This is a colossal issue. In several European countries, patients who have visited Greek hospitals are asked to fill out questionnaires and are treated in separate wards due to potential exposure to local superbugs.
– So, what are the strategies and best practices to counter the stealthy threat of antimicrobial resistance?
The primary step is the appropriate use of antibiotics. We must urgently alter our mindset and culture concerning antibiotic administration.
The second step involves infection prevention, both in the community and in hospitals. Regular vaccination is crucial to this effort. If we protect ourselves with vaccines against influenza, Covid, and other viruses, patients won’t develop cold symptoms and won’t unnecessarily seek antibiotics.
Good hygiene practices, such as hand hygiene and correct coughing etiquette to prevent germ spread, are also important. These are measures we’ve learned to adopt during the pandemic to limit germ transmission.
The third step focuses on monitoring and prevention of hospital-acquired infections. After all, without infection within the hospital, there’s no need for antibiotics and no subsequent development and evolution of the microbe into a more resistant organism, thereby breaking this vicious cycle.
Greece, it must be noted, has one of the highest rates of hospital-acquired infections in the EU, and these infections typically originate from particularly resistant microbes.
Lastly, we must urgently limit antibiotic use in animal husbandry. Today, several countries, including Denmark and other Scandinavian nations, have made significant strides in reducing the quantity of antibiotics used in animal feed.
In contrast, other countries, like the US, have a powerful lobby of feed producers who are pushing to maintain current levels of antibiotic use.
A coordinated and holistic global approach is therefore needed.
– You have been involved in this phenomenon for several years now and you know that reducing it requires a broader change in society’s attitude towards the use of antibiotics. So what is your message?
You are absolutely right, the change has to come from the people. The patient has to calmly ask their doctor, “Do you think I need the antibiotic or not? Is it necessary? Will it help me get better?” People need to become our allies in this effort and understand that an antibiotic is not a panacea for every case.
I’ll give you some examples of how the situation worsens every day: the common cold usually takes about five to six days to go away. The patient typically experiences symptoms for the first three days and then visits the doctor who prescribes an antibiotic. Two days later, the patient feels better, but they would have recovered anyway because this is the normal life cycle of a cold. These practices, however, solidify the misconception that the antibiotic is responsible for the cure. The problem is that antimicrobial resistance is a concept that seems too abstract for the patient, a phenomenon that in our minds only has long-term implications. Yet, there are dozens of excellent studies that highlight the multiple effects of our dependence on antibiotics.
Recently published research on the microbiome, the healthy microbes in the human body that we live with and keep us healthy, has shown that the constant and indiscriminate use of antibiotics alters the microbiome and increases the risk of autoimmune diseases.
We now know that the more antibiotics children take at an early age, the higher their risk of developing ulcerative colitis and Crohn’s disease.
Surveys based on doctors’ and patients’ perceptions of antimicrobial resistance conclude that everyone thinks it is a problem that is far away, somewhere out there. The reality, however, is that antimicrobial resistance is already here, on our doorstep, in our homes, in our doctors’ offices, and in our hospitals.
