Bacteria can change so quickly that even the most modern antibiotics are no longer effective (so-called antibiotic resistance). Every year, there are more and more strains of bacteria resistant to any antibiotics. Scientists warn that in 20-30 years the treatment of patients may become very difficult. What to do in order not to lose to more and more dangerous bacteria?

Even less than a hundred years ago, the fight against bacteria was virtually impossible, because the firstantibiotic- penicillin - began to be massively used only during World War II. With the introduction of antibiotics into therapy, many deadly diseases curable in just a few days or weeks. Unfortunately, the first penicillin-resistant staphylococci appeared a few years later. Currently, over 95 percent. strains of these bacteria are insensitive to penicillin antibiotics. Againtreatmentcan be ineffective and people die from pneumonia, meningitis or sepsis.

Antibiotic protection necessary

Why did this happen? The main reason is the widespread prescription of antibiotics by doctors and their inappropriate use by patients. Added to this is the widespread use of antibacterial preparations in veterinary medicine, farming, agriculture and the chemical industry. All this causes bacteria to defend themselves against them, change their DNA and eventually become indestructible. Mutant bacteria travel with patients all over the world. Recently, another wave of dangerous antibiotic-resistant infections caused by the intestinal bacteria Klebsiella KPC has reached Poland. Scientists and doctors warn that if we do not start to prudently and responsibly use antibiotic therapy, in a few years there may be dangerous epidemics, against which medicine will be powerless. To prevent this from happening, according to WHO guidelines, special programs are created around the world to prevent a catastrophe. The idea is to create a rational, controlled system for using these drugs so that bacteria do not become resistant to them so quickly. In Poland, the National Antibiotic Protection Program has existed since 2004.

According to an expertdr. n. med. Paweł Grzesiowski, European vaccination expert, member of the Polish Society of Vaccinology

More common sense inuse of antibiotics

The wave of resistant bacteria is gradually increasing. In order to delay this process, everything possible should be done to limit the use of antibiotics. We are warning the public that if antibiotics continue to be treated like a headache pill, they will soon stop working. It is also important to strictly enforce the rules of hygiene and disinfection in order to cut the pathways of bacterial transmission where human he alth is at stake.

How do antibiotics work?

Antibiotics can fight bacteria (including protozoa and fungi) in a variety of ways. They disrupt the life processes of these microorganisms and cause their death (bactericidal effect) or disrupt the metabolic changes taking place in their cells so as to limit reproduction (bacteriostatic effect). For example, drugs from the penicillin group block the activity of enzymes that stimulate the structure of bacterial walls, while streptomycin interferes with the synthesis of proteins inside bacteria, and gramicidin impairs the permeability of their cell membranes. However, bacteria, fighting for survival, are starting to defend themselves against it more and more effectively.

Where do antibiotic-resistant bacteria come from?

It is not bacteria that create resistance, but humans, using more and more antibiotics. Bacteria are changeable, they can live without oxygen and water. They gradually get used to the substances that destroy them. They try to outsmart the antibiotic by changing the structure of the cell wall so that the drug cannot tear it apart and reach its destination. They produce special enzymes that break down the antibiotic. Or through tiny holes in the wall, cells "pump" it out of their interior. In addition, they reproduce very quickly, every 20-40 minutes a new generation appears, which can adapt their genes to new conditions. The more antibiotics we use, the faster we do it. Immune to a given antibiotic, they immediately pass this skill on to their successors. As a result, the previously effective drug stops working. Scientists emphasize thatantibiotic resistance( antibiotic resistance)is always a consequence of medication use. Where little is used, there are fewer resistant bacteria or they appear sporadically. The greatest number of antibiotics is consumed by the Japanese and Americans, and in Europe - by the Greeks and the French. Poland is located more or less in the middle of European countries, but the use of these drugs is constantly increasing in our country.

Worth knowing

Antibiotic resistance: Poland is among the high-risk countries

According to the report of the European Center for Disease Prevention and Control (ECDC), Poland is among the countries where bacteria are particularlyhigh resistance to treatment. Scientists list as many as 6 pathogens that have become extremely dangerous for us. Among them are: coli (E. coli), pneumoniae (Klebsiella pneumoniae), blue oil (Pseudomonas aeruginosa), Acinetobacter, pneumoniae (Streptococcus pneumoniae) and faecal streptococcus (Enterococcus faecalis). Two of them - Acinetobacter and the blue oil rod - are classified as the highest risk.

Dangerous hospital infections

The most difficult situation is in hospitals, where the most antibiotics and disinfectant bactericides are used there. Thus, there are numerous cross-contamination. Bacteria transfer genetic information within one species and between species. As a result, mutants arise. The infection they cause is difficult to treat. Bacteria that survive in a hospital setting then go unpunished. Superbugs are resistant to at least two or three groups of drugs. A serious danger is posed by multi-drug resistant staphylococci from the hospital environment (the so-called MRSA, MRSE), which are sensitive to two or three out of several dozen antibiotics available on the market. Klebsiella pneumoniae, susceptible to one antibiotic, got out of control. They most often attack patients in cardiac surgery, general surgery, hematology, urology and intensive care departments. Their pneumonia and sepsis are often fatal. Gram-negative non-fermenting rods (Pseudomonas and Acinetobacter) are also dangerous. They appear in intensive care units and are sometimes resistant to all available antibiotics. A serious infection that attacks outside the hospital environment is pneumococcal pneumonia and meningitis. Doctors have at their disposal two or three antibiotics against these bacteria. Also, multi-drug resistant strains of streptococci, E. coli, and tuberculosis mycobacteria appeared. Treatment of people infected with superbugs requires a hospital stay and the administration of intravenous high doses of strong antibiotics. If the bacteria are not susceptible to any drug, then faith in the immunoglobulin-assisted immune system remains. However, some infections are not overcome this way.

Do not abuse antibiotics

Antibiotics were invented to heal specific diseases. Therefore, you only have to take them when you really need them. Badly chosen or taken just in case, instead of healing, they harm. The truth is that every sixth Pole uses an antibiotic on his own at least once a year. Busy and busy, we don't have time to get sick. When it scratches in the throat, breaks in the bones,at most we go to the doctor and ask for an antibiotic to get him back on his feet quickly. And the doctor is also a human being, and for the sake of peace of mind, he prescribes this antibiotic. Even a very bad mood or a high fever during a viral infection are no justification for resorting to an antibiotic. Because antibiotics for viruses don't work! However, there is a high probability that we will become resistant to the drug and when we get serious bacterial pneumonia or kidney disease, it will not help. Doctors often prescribe antibiotics to exaggerate. In the case of a boil, it is usually enough to cut the ulcer, release the pus, and apply a sanitizing dressing. The body has a great ability to fight bacteria, so you have to trust it more. But sometimes the use of an antibiotic is absolutely necessary. A woman with a bacterial infection must be given this medication during labor to avoid the infection of the baby. One dose of a strong antibiotic solves the problem. Today, when there are plenty of antibiotics on the market, you need to use them rationally. This is to be facilitated by guidelines developed by experts, e.g. recommendations for the treatment of the respiratory system prepared by specialists from the National Medicines Institute. Modern intravenous antibiotics in hospitals should only be recommended for the most severe infections according to international and national treatment regimens.

Don't regret the antibiogram

It is best to answer the question what kind of bacteria caused the infection and to which chemicals it is sensitive before starting the treatment. For this purpose, a culture test with an antibiogram should be performed. First, a swab is taken from a site where a bacterial infection has developed, such as the throat, nose, or blood or urine samples are taken. Then a microbiological test is performed to isolate the microorganism responsible for the development of the disease and check its sensitivity to various antibiotics. Based on this, the doctor can prescribe a medicine that best deals with a specific strain of bacteria. Some specialists recommend such a test already before starting the first antibiotic treatment, and until the result is obtained (3-7 days), they use milder preparations. However, most choose an antibiotic right away based on the symptoms of the disease. In the case of acute infections, it is justified, because delaying treatment may cause serious complications. The test must be done whenever infections recur, instead of "blind" administering another antibiotic in the hope that it will help. So why are patients reluctant to such tests? Doctors blame this on the national he alth system. The problem is that the antibiogram (like the CRP test, which tells you aboutorganism response to infection, or the test for detecting group A streptococcal antigen in throat swabs) is not reimbursed by the National He alth Fund. This means that the doctor pays for the examination "from his own pool". This should not exempt a specialist from reliable diagnostics. However, the test often depends on its motivation. You can always ask your doctor for a referral. Taking an antibiogram in a private laboratory costs about PLN 60.

Vaccinations and phages: weapons against bacteria

In order to reduce the use of germicides and reverse the negative trend leading to the antibiotic resistance pandemic, we need to take care of prevention. Vaccinations are the best protection against disease, so they should be as widely available as possible, preferably through insurance. Unfortunately, pneumococcal or meningococcal vaccines are not yet on the compulsory vaccination calendar, which means you have to pay for them out of your own pocket. Doctors sound the alarm: we need to get vaccinated to avoid serious diseases. This is especially true for children, the elderly and those with reduced immunity. Work is still underway on new vaccines, e.g. against staphylococcus aureus,E. coli , chopsticksKlebsiella . It is said that they will be given to every sick person on admission to hospital. But that's the future. For now, strict adherence to the rules of cleanliness and hygiene as well as aseptic conditions during the procedures remains. It is not difficult or costly. Most of the bacteria die at 50-60 ° C and in contact with alcohol-based disinfectants. Alternative methods of treatment are also being sought. Medicine is increasingly using the services of phages. These are viruses that stick to bacteria and inject their genetic material inside. Then, the production of phage particles begins in the bacterial cell, they burst the bacteria from the inside. However, this method works only in the treatment of infections that do not develop rapidly. It takes time to find a phage that can kill a specific bacterium. And in the case of sepsis, you need to act immediately. According to the statistics of the main phage laboratory in Wrocław, several thousand patients are treated in this way every year in Poland. There is an ongoing search for new technologies that would allow the drug substance to crack down on the bacteria at the cell level. The future is electronic circuits with a biological fragment (microchips). They will find application in recognizing and killing bacteria. For now, however, antibiotics remain the best weapon in the fight against bacteria. And because they take longer to build up than bacteria do for them to mutate, they need to be used more carefully.

Don't do that

» Do not take the antibiotic on your own (nasal drops, syrup, a warm bed will help with colds). »Do not stop the treatment even when you feel better (some bacteria will start to multiply again, causing the disease to come back, in addition, germs will already be able to recognize the drug and defend themselves against it).» Do not change the hours you take the antibiotic and do not change the doses to keep the blood level of the drug constant (when it is not enough, the bacteria will multiply and figure out how to defeat it).» Do not take the drug with citrus juices or milk (they make it difficult to absorb the drug ).

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