LAS SUPERBACTERIAS: la amenaza durmiente que vive entre nosotros
In recent weeks we have begun to hear about a hitherto unknown concept: multi-resistant bacteria or superbugs, a threat capable of creating a new health situation as critical or even more so than the pandemic we have just experienced. And it is also a problem about which alarm bells have been ringing for several years now.
But let's start at the beginning... what are multi-resistant bacteria or superbugs? Son cepas de bacterias que se han hecho resistentes a los antibióticos. Esto no siempre ha sido así, se trata de una evolución: al principio sí eran sensibles, por lo que al tomar el tratamiento nuestro cuerpo podía ganar la batalla fácilmente.
Este cambio tan ventajoso para ellas y tan preocupante para nosotros ha ocurrido principalmente por un motivo: nuestro misuse of antibiotics such as taking them when it was not necessary, for example, for viruses such as flu for which the antibiotic is useless; not following the guidelines indicated by the doctor "if I feel well, I'll stop taking it"; or taking generic antibiotics and not specific antibiotics against the bacteria that we wanted to eliminate.
To give an idea of what this means, we can say that today superbugs kill 1.2 million people a year. This means that deaths from superbugs are higher than those caused by AIDS, malaria, or lung cancer.
As we said at the beginning, this is not new. In fact, it was anticipated by Dr. Alexander Fleming when, in his Nobel Prize speech for the discovery of penicillin, he commented as follows:
The time may come when penicillin can be bought by anyone in the shops. Then there is a danger that the ignorant man could easily administer a lower dose than necessary and by exposing his microbes to non-lethal amounts of the drug make them resistant. Here is a hypothetical example. Mr. X. has a sore throat. He buys some penicillin and administers it to himself, but not enough to kill the streptococci, but enough to educate them to resist the penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin, the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X's death? Mr. X, whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin, use enough.
But what really happens if we don't take the right dose? Let's imagine a battlefield where bacteria are the attackers and on the other side we are with the weapons at our disposal, arrows (antibiotics), the vast majority of these bacteria have no shield and our arrows destroy them, but a very small number of them have a shield that protects them and that they have acquired by a natural mutation. If we fire the right number of arrows for the right amount of time, the arrows that wound and kill these bacteria will slip through the cracks in the shield, but if we stop the battle early because most of them have died, these shielded bacteria will survive and form a new army, all of them with shields. In addition, they have learned that arrows are our weapons and for the next fight they will go with seamless shields. They are also able to transmit the information on how to generate these shields to other bacteria and acquire instructions for new shields, thus producing multi-resistant bacteria. Yes, indeed, bacteria do exchange information with each other.
But it must be said that this resistance would have occurred naturally as mutations occur spontaneously and cause bacteria to adapt to their environment. What has happened is that we have significantly accelerated this process by our behaviour. In addition, there is also a time lag between this resistance of bacteria and the production of new antimicrobials. Let's say that superbugs are quicker to become resistant than we are in developing antibiotics for them. And a pharmaceutical company investing millions of euros in antibiotics against bacteria that are no longer sensitive to the drug in a short period of time would be a huge failure, so many will discard these investments. This could lead to a new health problem catching us without resources, as has happened with the case of the coronavirus. The World Health Organisation (WHO) has already warned that this is one of the greatest threats to global health..
It is in hospital environments that the greatest umber of multi-resistant bacteria originate, as antibiotics are routinely used as a preventive barrier in any intervention or as a treatment for infections that occur. These are found in patients, but also on the surfaces with which they interact, so cross-contamination is very easy to occur and despite entering the hospital for another reason an infection may be acquired and become multidrug-resistant, which means an increase in the length of hospitalisation and a higher risk of poor prognosis. In a worst-case scenario, the day may come when we are as we were before the discovery of antibiotics, when a simple wound could be lethal.
But there is hope; the warnings and concern on the part of the health authorities is leading to greater public awareness of the correct use of antibioticsand there are studies of alternatives such as the use of bacteriophages, vaccines, antibodies etc. And the implementation of protocols for cleaning and disinfecting hospital areas to prevent cross-contamination and the spread of infections, especially if a patient is detected with a multidrug-resistant infection.
With regard to this last point, it must be considered that the established cleaning and disinfection protocols are not perfect; the human factor or the use of inappropriate products means that, according to the latest studies, 50% of the surfaces of hospital rooms are not sufficiently disinfected before the admission of a new patient.
There are complementary systems such as germicidal equipment that have proven to be highly effective in reducing the risk of transmission of microorganisms, such as those that work with ultraviolet-C, since correctly installed they can affect the vast majority of surfaces and inactivate any type of microorganism, without exception, since in this case there is no pathogen that can resist inactivation for this technology, whether it is a superbug or not.
We have a new threat staring us in the face, but if SARS-CoV-2 has taught us anything, it is that we have the capacity and the tools to combat any problem that comes our way.
And success is mainly based on acting in advance:
PREVENTION IS THE KEY, and we must start NOW.
VERÓNICA VIDAL
RESPONSIBLE FOR BIODOSIMETRY AND INNOVATION - FOTOGLASS
FOTOGLASS is a leading bio-optics company combining physical optics and biomedicine. Its activity focuses on the use of light as a tool to solve problems in a living environment, such as the inactivation of pathogens by ultraviolet C, the ability to accurately discern between tumor and non-tumor tissue by nanoplasmonic technology, the use of chromatography within food or the creation of smart textiles. It collaborates with the Marqués de Valdecilla University Hospital and the University of Cantabria. For more info: https://www.fotoglass.es