The fight against antibiotic resistance: global challenges.

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The fight against antibiotic resistance: global challenges

I. Antibiotic resistance: scale and consequences of a global threat

Antibiotic resistance (AMR) is a global health problem that threatens modern medicine. It occurs when bacteria, viruses, fungi and parasites change over time and no longer react to drugs intended for their destruction. This makes infections more difficult to treat and increases the risk of diseases, serious illnesses and death. Antibiotic resistance is not a new problem, but its growth rates and geographical spread cause serious concern. It threatens to achieve healthcare, which we are accustomed to consider to be granted, including complex operations, organs transplantation and chemotherapy. If urgent measures are not taken, we risk returning to the era, when even ordinary infections can be fatal.

  • 1.1. Mechanisms for the development of antibiotic resistance:

    • Mutations: Bacteria multiply quickly, and during this process mutations may occur in their genetic material. Some of these mutations can give bacteria resistance to antibiotics. The bacterium with such a mutation will survive when exposed to the antibiotic, while other bacteria will die. Then this stable bacterium can multiply and transmit stability to its offspring.
    • Acquisition of resistance genes: Bacteria can acquire resistance genes from other bacteria through various mechanisms, such as:
      • Transformation: The bacterium absorbs DNA containing resistance genes from the environment (for example, from dead bacteria).
      • Transduction: Viruses (bacteriophages) that infect bacteria can transfer resistance genes from one bacterium to another.
      • Conjugation: Bacteria can transmit resistance genes to each other through direct physical contact using plasmid (small, ring molecules of DNA). Plasmides can contain many resistance genes and easily spread between bacteria.
    • Selective pressure: The use of antibiotics creates selective pressure, which contributes to the survival and reproduction of stable bacteria. The more antibiotics are used, the more selective pressure, and the faster the antibiotic resistance spreads.
    • Biofilers: Bacteria often form biofilles – bacteria communities enclosed in an extra -ceremony of polymer substances. Biologans protect bacteria from antibiotics and the host’s immune system, which complicates the treatment of infections associated with biofilles.

  • 1.2. Factors contributing to the spread of Amr:

    • Excessive and improper use of antibiotics: This is the most important factor that contributes to the spread of AMR. Antibiotics are often prescribed for viral infections, such as colds and flu, on which they do not act. In addition, patients often do not finish the course of antibiotic treatment, which also contributes to the development of resistance.
    • Using antibiotics in agriculture: Antibiotics are widely used in agriculture to prevent diseases and stimulate animal growth. This leads to the development of resistant bacteria in the intestines of animals, which can then be transmitted to people through a food chain or through direct contact with animals.
    • Insufficient hygiene and sanitation: Poor hygiene and sanitation contribute to the spread of bacteria, including resistant bacteria. This is especially true in hospitals and other medical institutions where the risk of cross infection is high.
    • Globalization and travel: Globalization and travel contribute to the spread of resistant bacteria between countries and continents. People infected with resistant bacteria can travel and spread infection to other regions.
    • Insufficient financing of research and development: The development of new antibiotics is an expensive and complex process. In recent years, financing of research and development of new antibiotics has declined, which puses a threat to our ability to fight AMR.
    • Lack of global coordination: The fight against AMR requires global coordination and cooperation between countries. The lack of such coordination makes it difficult to fight this problem.

  • 1.3. The consequences of antibiotic resistance to human health:

    • Longer hospitalization dates: Infections caused by resistant bacteria are more difficult to treat, which leads to a longer hospitalization.
    • Increase in mortality: Resistant infections are associated with increased mortality. According to estimates, in Europe, 33,000 people die annually from resistant infections. On a global scale, this figure is much higher.
    • Increase in the cost of treatment: Treatment of resistant infections requires the use of more expensive antibiotics, and may also require more intense care, which leads to an increase in the cost of treatment.
    • Limited treatment opportunities: As bacteria become resistant to more and more antibiotics, the possibility of treating infections becomes increasingly limited. In some cases, infections can become incurable.
    • The risk of disruption of the achievements of medicine: AMR is jealous of achieving medicine, which depend on effective antibiotics, such as surgery, organs transplantation and cancer treatment.

II. Antibiotic resistance in Russia: Features and problems

Antibiotic resistance is a serious problem in Russia, as well as around the world. However, in Russia, this problem has its own characteristics related to historical, social and economic factors. The level of antibiotic resistance to some bacteria in Russia is higher than in other European countries. This is due to a number of factors, including the wide and not always rational use of antibiotics, problems with infectious control in medical institutions and limited financing of research in the field of AMR.

  • 2.1. The epidemiological situation on antibiotic resistance in Russia:

    • High level of resistance to common antibiotics: Studies show that in Russia there is a high level of resistance to common antibiotics, such as penicillins, cephalosporins and macrolides. This means that these antibiotics are less effective for the treatment of common infections, such as pneumonia and urinary tract infections.
    • Distribution of multi -resistant microorganisms (MDRO): In Russia, like around the world, there is a spread of multi-resistant microorganisms, such as methicillin-resisted golden staphylococcus (MRSA), vanimicin-resistant enterococcus (Vre) and carbapenem-resistant enterobacteria (Cre). These microorganisms are resistant to many antibiotics, which makes the treatment of infections caused by them extremely complex.
    • Regional differences: The level of antibiotic resistance can vary depending on the region of Russia. This may be due to the differences in the practice of using antibiotics, the level of healthcare development and socio-economic factors.
    • Data failure: The collection of data on antibiotic resistance in Russia is still at the development stage. Data failure makes it difficult to assess the scale of the problem and develop effective strategies for the fight against AMR.

  • 2.2. Factors contributing to the development of antibiotic resistance in Russia:

    • Excessive and irrational use of antibiotics:
      • Uncontrolled sale of antibiotics: Until recently, antibiotics in Russia could be purchased without a doctor’s prescription. This led to the wide and irrational use of antibiotics, including in viral infections that they do not act on. In recent years, measures have been taken to limit the sale of antibiotics without a recipe, but the problem is still preserved.
      • The appointment of antibiotics for viral infections: Many doctors in Russia still prescribe antibiotics for viral infections, such as colds and influenza, which is unreasonable and contributes to the development of resistance.
      • Non -compliance with recommendations for the use of antibiotics: Some doctors do not follow recommendations for the use of antibiotics, such as the choice of the correct antibiotic, dosage and duration of treatment.
    • Problems with infectious control in medical institutions:
      • Insufficient hand hygiene: Insufficient hygiene of the hands of medical personnel contributes to the spread of resistant bacteria in hospitals and other medical institutions.
      • Insufficient disinfection and sterilization: Insufficient disinfection and sterilization of medical equipment and premises also contribute to the spread of resistant bacteria.
      • Overflow of hospitals: The overflow of hospitals increases the risk of cross infection between patients.
    • Using antibiotics in agriculture:
      • Using antibiotics to stimulate growth: Antibiotics are widely used in agriculture to stimulate animal growth. This leads to the development of resistant bacteria in the intestines of animals, which can then be transmitted to people through a food chain or through direct contact with animals.
      • Lack of control over the use of antibiotics in agriculture: In Russia, there is no strict control over the use of antibiotics in agriculture.
    • Low level of awareness of the population about antibiotic resistance:
      • Lack of information about antibiotics: Many people in Russia do not have sufficient information about antibiotics, their use and consequences of improper use.
      • Antibiotic self -medication: Many people self -medicate antibiotics, which contributes to the development of resistance.
    • Limited financing of research in the field of AMR:
      • Lack of new antibiotics: The development of new antibiotics is an expensive and complex process. In Russia, financing of research and development of new antibiotics is limited, which puses a threat to our ability to fight AMR.
      • Lack of financing for AMR monitoring: The lack of funding for monitoring AMR makes it difficult to assess the scale of the problem and develop effective strategies for the fight against AMR.

  • 2.3. The consequences of antibiotic resistance to the Russian health system:

    • Increased incidence and mortality: Antibiotic resistance leads to an increase in incidence and mortality from infections.
    • Increase in the cost of treatment: Treatment of resistant infections requires the use of more expensive antibiotics, and may also require more intense care, which leads to an increase in the cost of treatment.
    • Health system load: Antibiotic resistance increases the load on the healthcare system, requiring more resources for the treatment of infections.
    • Reducing the effectiveness of treatment: Antibiotic resistance reduces the effectiveness of the treatment of infections, which can lead to a deterioration in patients and the need for more complex and expensive treatment methods.

III. Global strategies for the fight against antibiotic resistance

The global fight against antibiotic resistance requires coordinated efforts at the international, national and local levels. It is necessary to accept complex strategies covering various aspects, including the rational use of antibiotics, improving infectious control, developing new antibiotics and alternative treatment methods, increasing the knowledge of the population and strengthening global coordination.

  • 3.1. Global plan of action to combat AMR:

    • Designed by the World Health Organization (WHO): WHO has developed a global action plan to combat AMR, which is a framework document for countries that develop and implement their own national plans for actions.
    • Five strategic goals: The global action plan includes five strategic goals:
      • Improving the awareness and understanding of AMR: It is necessary to increase the awareness of the population, medical workers and persons who make decisions on antibiotic resistance and its consequences.
      • Strengthening the epidemic and scientific research: It is necessary to strengthen the epidemic for AMR and conduct scientific research for a better understanding of the mechanisms of resistance and developing new methods of combating it.
      • Reducing the frequency of infections: It is necessary to reduce the frequency of infections using prevention measures, such as vaccination, hand hygiene and the safe use of medical devices.
      • Optimization of the use of antimicrobials: It is necessary to optimize the use of antimicrobial drugs in medicine, agriculture and veterinary medicine in order to reduce selective pressure that contributes to the development of resistance.
      • Ensuring sustainable investments in the fight against AMR: It is necessary to ensure stable investments in the fight against AMR, including research and development of new antibiotics and alternative treatment methods.
    • The role of countries: The global action plan calls on the countries to develop and implement their own national plans to combat AMR, based on five strategic purposes.

  • 3.2. Rational use of antibiotics:

    • Limiting the use of antibiotics for viral infections: Antibiotics do not act on viruses, so they should not be prescribed for viral infections, such as colds and flu.
    • The appointment of antibiotics only if necessary: Antibiotics should be prescribed only with bacterial infections, when they are really necessary.
    • Choosing the right antibiotic: When prescribing an antibiotic, it is necessary to choose the most effective antibiotic, which has the least risk of resistance.
    • Dosage and duration of treatment: It is necessary to prescribe the correct dosage of the antibiotic and observe the recommended duration of treatment.
    • Information of patients: Patients must be informed about the proper use of antibiotics and the importance of compliance with the doctor’s recommendations.
    • Antimicrobial Stewardship Programs – ASP) control programs: ASP) ASP is programs aimed at optimizing the use of antibiotics in medical institutions. They include monitoring the use of antibiotics, the development of recommendations for their use and training of medical personnel.

  • 3.3. Improving infectious control:

    • Hand hygiene: Hand hygiene is one of the most important ways to prevent the spread of infections, including resistant infections. Medical workers must thoroughly wash their hands before and after contact with patients, as well as after contact with blood or other biological fluids.
    • Using personal protective equipment (PPE): Medical workers must use PPE, such as gloves, masks and robes, to protect themselves and patients from infections.
    • Disinfection and sterilization: Medical equipment and surfaces should be regularly disinfected and sterilized to destroy bacteria and other microorganisms.
    • Isolation of patients with infections: Patients with infections caused by resistant bacteria should be isolated from other patients to prevent the spread of infection.
    • Epideminos for infections: Medical institutions must conduct an epidemic for infections in order to track the spread of resistant bacteria and take measures to prevent their distribution.

  • 3.4. Development of new antibiotics and alternative treatment methods:

    • Investments in research and development: It is necessary to increase investments in the research and development of new antibiotics and alternative treatment methods such as phagish therapy and immunotherapy.
    • Stimulating the development of new antibiotics: It is necessary to stimulate pharmaceutical companies to develop new antibiotics, for example, by providing tax benefits and other incentives.
    • Alternative treatment methods: It is necessary to investigate and develop alternative methods of treating infections, such as phagish therapy (the use of viruses for the destruction of bacteria), immunotherapy (strengthening the body’s immune response to combat infection) and the development of new antimicrobial drugs that are not traditional antibiotics.

  • 3.5. Increased awareness of the population:

    • Information of antibiotic resistance: It is necessary to inform the population about antibiotic resistance, its causes and consequences.
    • Popularization of the rational use of antibiotics: It is necessary to popularize the rational use of antibiotics and explain when they must be used and when their use is impractical.
    • Prevention of infections: It is necessary to encourage the prevention of infections, for example, by vaccination and compliance with hygiene rules.
    • The role of SMI: The media play an important role in increasing the knowledge of the population about antibiotic resistance.

  • 3.6. Strengthening global coordination:

    • Cooperation between countries: It is necessary to strengthen cooperation between countries to combat AMR, for example, by exchange of information and coordination of strategies.
    • The role of international organizations: International organizations, such as WHO, play an important role in coordinating global efforts to combat AMR.
    • The single approach “One Health”: It is necessary to use the single approach “One Health”, which recognizes the relationship of human health, animal health and environmental health. This means that it is necessary to take into account the influence of the use of antibiotics in agriculture and veterinary medicine on the development of resistance in people.

IV. Antibiotic resistance in agriculture and food industry

The use of antibiotics in agriculture and the food industry is an important factor that contributes to the development and spread of antibiotic resistance. Antibiotics are widely used to prevent diseases, stimulation of growth and treatment of infections in agricultural animals. This leads to the development of resistant bacteria in the intestines of animals, which can then be transmitted to people through the food chain, through direct contact with animals or through environmental pollution.

  • 4.1. Using antibiotics in animal husbandry:

    • Preventive use: Antibiotics are often used prophylactically to prevent diseases in animals contained in high density conditions. This is especially common in industrial livestock.
    • Growth stimulation: Some antibiotics are used to stimulate animal growth. The mechanism of action of antibiotics as growth stimulants is not completely understandable, but it is believed that they affect the intestinal microbiota, which leads to an improvement in the absorption of nutrients.
    • Infection treatment: Antibiotics are also used to treat infections in animals.
    • The consequences of using antibiotics: The use of antibiotics in animal husbandry leads to the development of resistant bacteria in the intestines of animals. These resistant bacteria can be transmitted to people through different paths.

  • 4.2. Ways to transmit resistant bacteria from animals to people:

    • Food chain: Resistant bacteria can be transmitted to people through a food chain, for example, when drinking meat infected with resistant bacteria. Infection of meat can occur during slaughter and processing.
    • Direct contact with animals: People working with animals (for example, farmers, veterinarians) have an increased risk of infection with resistant bacteria.
    • Environmental pollution: Resistant bacteria can fall into the environment through animal manure. This can lead to water and soil pollution, as well as to the spread of resistant bacteria in the environment.
    • Horizontal transfer of genes: Resistant bacteria in the environment can transmit resistance genes to other bacteria, including bacteria that can infect people.

  • 4.3. Measures to reduce the use of antibiotics in agriculture:

    • The ban on the use of antibiotics to stimulate growth: Many countries have banned the use of antibiotics to stimulate animal growth.
    • Restriction of the preventive use of antibiotics: It is necessary to limit the preventive use of antibiotics and use them only if necessary, under the control of the veterinarian.
    • Improving animal content conditions: Improving the conditions of animal content (for example, reducing the density of content, improvement of hygiene) can reduce the need for antibiotics.
    • Vaccination: Animal vaccination can help prevent diseases and reduce the need for antibiotics.
    • Alternative treatment methods: It is necessary to develop and use alternative methods of treating infections in animals, such as herbal medicine and homeopathy.
    • Monitoring the use of antibiotics: It is necessary to monitor the use of antibiotics in agriculture to track trends and evaluate the effectiveness of measures to reduce the use of antibiotics.

  • 4.4. The role of the food industry in the fight against AMR:

    • Hygiene and food safety: The food industry must comply with strict rules of hygiene and food safety to prevent food infection with resistant bacteria.
    • Control over suppliers: The food industry must control its suppliers and demand that they comply with the rules of rational use of antibiotics in animal husbandry.
    • Information of consumers: The food industry should inform consumers about risks associated with antibiotic resistance, and how they can reduce their risk of infection with resistant bacteria.

V. Laboratory diagnosis of antibiotic resistance

Laboratory diagnosis of antibiotic resistance plays an important role in the fight against AMR. It allows you to identify resistant bacteria and determine their sensitivity to various antibiotics, which helps doctors choose the most effective methods of treating infections. In addition, laboratory diagnostics is used to monitor the spread of resistant bacteria and to evaluate the effectiveness of measures to combat AMR.

  • 5.1. Methods for determining antibiotic sensitivity:

    • Disk method: The method of discs is one of the most common methods for determining antibiotic sensitivity. On a cup of Petri with agar, sown with a culture of bacteria, wheels are placed, soaked in various antibiotics. After incubation, the diameter of the growth zone is measured around each disk. The diameter of the growth zone of growth depends on the sensitivity of bacteria to the antibiotic.
    • Serial breeding method: The method of serial breeding is used to determine the minimum inhibitory concentration (MIC) of the antibiotic. Mick is the lowest concentration of an antibiotic that suppresses the visible growth of bacteria. The method consists in the preparation of a series of breeding antibiotics and adding them to the culture of bacteria. After incubation, MIK is determined by the absence of visible growth of bacteria in test tubes with different antibiotic concentrations.
    • Method is Testov: The E-test method combines the elements of the disk method and the method of serial dilutions. An e-test is a plastic strip on which a graduated scale of antibiotic concentrations is applied. The strip is placed on a cup of Petri with agar, sown with a culture of bacteria. After incubation, MIK is determined at the point where the growth zone of growth crosses the scale of concentrations of the antibiotic.
    • Automated systems: There are automated systems for determining antibiotic sensitivity, which allow you to quickly and accurately determine the mick for a large number of antibiotics. These systems use various methods, such as nephelometry (measurement of turbidity) and fluorimetry (measurement of fluorescence).

  • 5.2. Methods for identifying resistance genes:

    • Polymerase chain reaction (PCR): PCR is a molecular method that is used to detect resistance genes in bacteria DNA. PCR allows you to quickly and accurately identify resistance genes, even if bacteria do not show phenotypic resistance to antibiotics.
    • DNA sequencing: DNA sequencing allows you to determine the nucleotide sequence of resistance genes. This allows you to identify new resistance genes and study the evolution of resistance.
    • Hybridization of nucleic acids: Hybridization of nucleic acids is a method that is used to detect resistance genes by hybridization of bacterial DNA with a DNA zone complementary to the resistance gene.

  • 5.3. The value of laboratory diagnostics for clinical practice:

    • The choice of antibiotic therapy: The results of laboratory diagnostics of antibiotic sensitivity help doctors choose the most effective antibiotics to treat infections.
    • Monitoring the effectiveness of treatment: Laboratory diagnostics can be used to monitor the effectiveness of treatment of infections.
    • Prevention of resistance spread: Laboratory diagnostics helps to identify resistant bacteria and take measures to prevent their distribution.
    • Epidemiological supervision: Laboratory diagnostics is used for epidemiological supervision of AMR, which allows you to track the spread of resistant bacteria and evaluate the effectiveness of measures to combat AMR.

  • 5.4. Problems of Amr laboratory diagnostics:

    • Insufficient funding: Insufficient financing of laboratory diagnostics, AMR can lead to insufficient equipment of laboratories and to use outdated methods.
    • Lack of qualified specialists: The lack of qualified specialists in the field of laboratory diagnostics AMR can lead to errors in the diagnosis and to improper interpretation of the results.
    • Lack of standards: The lack of standards in laboratory diagnostics AMR can lead to differences in the results obtained in different laboratories.
    • Slow implementation of new technologies: The slow introduction of new technologies in laboratory diagnostics AMR can lead to a delay in detection of resistant bacteria and to the use of non -optimal treatment methods.

VI. New antibiotics and alternative treatment methods

The development of new antibiotics and alternative methods of treatment is extremely important for the fight against antibiotic resistance. As bacteria become resistant to existing antibiotics, it is necessary to develop new drugs and treatment methods that could effectively fight infections. However, the development of new antibiotics is a complex and expensive process, and in recent years there has been a decrease in the interest of pharmaceutical companies in this area.

  • 6.1. Classes of new antibiotics:

    • Cephalosporins with beta-lactamaz inhibitors: These antibiotics are a combination of cephalosporin (antibiotic of beta-lactamal series) and inhibitor beta-lactamaz (enzyme that destroys beta-lactam antibiotics). This combination allows you to expand the spectrum of cephalosporin activity and make it effective against bacteria that are resistant to other beta-lactam antibiotics.
    • Fluoroquinolones: Forchinolones are antibiotics that inhibit DNA gyrez, an enzyme necessary for replication of bacterial DNA. Forchinolones have a wide range of activity and are used to treat various infections, including urinary tract infections, pneumonia and skin and soft tissue infections.
    • Lipopeptides: Lipopeptides are antibiotics that bind to the cell membrane of bacteria and disrupt its structure and function. Lipopeptides are used to treat infections caused by gram-positive bacteria, such as methicillin-resisted golden staphylococcus (MRSA) and vancico-resistant enterococcus (Vre).
    • Oxazolidinons: Oxazolidinones are antibiotics that inhibit the synthesis of bacterial protein. Oxazolidinons are used to treat infections caused by gram -positive bacteria, such as MRSA and Vre.
    • Tetracyycles: Tetracyclines are antibiotics that inhibit the synthesis of bacterial protein. Tetracyclines have a wide range of activity and are used to treat various infections, including skin and soft tissue infections, pneumonia and sexually transmitted infections.

  • 6.2. Alternative treatment methods:

    • Phagic therapy: Phagic therapy is a method of treating infections using bacteriophages (viruses that infect bacteria). Bacteriophages are specific for certain types of bacteria and destroy them without affecting other bacteria or body cells. Phagic therapy is a promising method of treating infections caused by resistant bacteria, especially in cases where antibiotics are ineffective.
    • Immunotherapy: Immunotherapy is a method of treating infections, which is aimed at increasing the body’s immune response to combat infection. Immunotherapy may include the use of vaccines, immunomodulators and other drugs that stimulate the immune system.
    • Antimicrobial peptides: Antimicrobial peptides are small proteins that have antimicrobial activity. They can destroy bacteria, violating the structure of their cell membrane. Antimicrobial peptides are a promising method of treating infections caused by resistant bacteria.
    • Probiotics: Probiotics are living microorganisms, which, when taken in sufficient quantities, have a beneficial effect on the health of the owner. Probiotics can be used to prevent and treat infections, modulating the intestinal microbiota and enhancing the immune response.
    • Phytotherapy: Phytotherapy is a method of treating infections using medicinal plants. Many plants contain substances with antimicrobial activity. Phytotherapy can be used as an addition to antibiotic therapy or as an alternative method of treating infections caused by resistant bacteria.

  • 6.3. Problems of developing new antibiotics:

    • High cost: The development of new antibiotics is an expensive process. The cost of developing one new antibiotic can reach several billion dollars.
    • Long development term: The development of a new antibiotic takes a long time, usually from 10 to 15 years.
    • Low profitability: The development of new antibiotics can be unprofitable for pharmaceutical companies, since their use is usually limited by cases of infections caused by resistant bacteria.
    • Resistance to new antibiotics: Bacteria can quickly develop resistance to new antibiotics, which reduces their effectiveness.
    • Regulatory barriers: Regulatory barriers can complicate and slow down the process of approval of new antibiotics.

  • 6.4. Stimulating the development of new antibiotics:

    • State financing: It is necessary to increase state financing of research and development of new antibiotics.
    • Tax benefits: It is necessary to provide tax benefits to pharmaceutical companies engaged in the development of new antibiotics.
    • Extension of patent protection: It is necessary to extend the term of patent protection of new antibs

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