Hospital infections associated with the risk of emergence of new strains of microorganisms resistant to medications used for treatment are a growing global health problem.
According to a report published in The Lancet Regional Health magazine in September, antimicrobial resistance caused, in 2019 alone, almost 600,000 deaths in the Americas region. Deaths are associated with infections caused by antibiotic-resistant bacteria, with at least 141,000 cases with a direct link.
In the same year, 1.27 million deaths occurred due to antimicrobial resistance worldwide.
And, according to a survey by IHME (Institute for Health Metrics and Statistics), linked to the University of Washington (USA), 1 in every 5 deaths from resistant bacterial infections worldwide are children up to 5 years old. years, often associated with treatable conditions.
For this reason, the WHO (World Health Organization) issued an alert about the risk to public health of so-called “super resistant bacteria”, or “superbugs”. According to the agency, the health problems caused by these microorganisms and the number of deaths resulting from these infections is even greater than those caused by other types, such as malaria and HIV.
In Brazil, deaths associated with microbial resistance are scarce, partly due to the lack of notification from private hospital services, which do not make this information available because they consider it to be sensitive patient data. Anvisa (National Health Surveillance Agency), however, is responsible for monitoring infections related to healthcare, as well as resistance to antimicrobials in the country.
According to data from the agency, the incidence of new infections linked to the problem in the country had been falling since 2012. However, in the three years of the pandemic, cases reported by hospital centers rose again.
Maria Cláudia Stockler de Almeida, assistant physician in the division of infectious and parasitic diseases clinics at the Central Institute of the Hospital das Clínicas at USP (University of São Paulo), explains that there are four main types of infections linked to healthcare. These are primary bloodstream infections associated with the central venous catheter (inserted into the bloodstream); urinary tract infections associated with an indwelling urinary catheter (bladder probe); hospital pneumonia associated or not with mechanical ventilation (or respirators, which were widely used during the Covid pandemic); and surgical site infections (during the post-operative period at the site where the cut was made).
“All hospitals and health centers must invest in quality and prevention programs to prevent this type of infection from occurring,” he states.
There is also the emergence of resistant strains outside the hospital environment, mainly linked to the indiscriminate use of antibiotics, but not only that. “We avoid the term ‘superbugs’ because it implies that they are super powerful, and they are not; they have some mechanism that favors resistance to certain antibiotics”, says the doctor.
Despite all the health risks, experts criticize that a more forceful position from the WHO, such as classifying the situation as a global health emergency, has never been adopted in the last four decades. “For this reason, a global surveillance and monitoring system would be important”, argues Claudio Maierovitch, public health doctor, researcher at Fiocruz (Oswaldo Cruz Foundation) and vice-president of Abrasco (Brazilian Public Health Association).
He highlights the importance of understanding that the origin of resistant forms is part of the natural selection that normally occurs between new generations of microorganisms.
As resistance can occur in both hospital and community environments due to the consumption of products and foods that use a wide variety of antibiotics in their production, there is a high risk of hospitalizations in groups that require special health care, such as the elderly and children. “It is these two extremes of age that have the greatest risk, both newborns and older individuals”, says pediatric infectious disease specialist Renato Kfouri.
In the case of Brazil, the Ministry of Health monitors some bacteria of interest. Among them are those most linked to healthcare-related infections: the gram-negative bacteria Acinetobacter spp., Klebsiella pneumoniae, Klebsiella spp., Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli; and the gram-positive species Staphylococcus aureus, coagulase-negative Staphylococcus and Enterococcus.
“The champions are enterobacteria, Klebsiella, Escherichia coli and Staphylococcus, which are closely associated with the development of pediatric infections and require constant monitoring”, says the doctor. Among cases associated with mechanical ventilation in Brazil, those in pediatric and neonatal ICUs (intensive care units) increased in the first two years of the pandemic.
Since 2010, Anvisa has required the retention of prescriptions for the sale of medicines such as antibiotics, aiming to reduce the purchase of medicines associated with the generation of multi-resistant bacteria. “Now, it is important to remember that there is indiscriminate, incorrect use, which leads to this resistance, but there is also the resistance mechanism of adequate, correct use, but which is not done with the best attention. Therefore, hospitals today speak of a ‘stewardship’ protocol [administração]which is the correct dose for the correct patient for the correct time”, adds Maierovitch.
Finally, in addition to better regulation of the use of antibiotics, experts reinforce that drug development companies must invest in research into new drugs.
“There is a problem today which is the lack of investment in the development and research of new antibiotics. And this is a big failure because the pharmaceutical industries have no interest, since they are medicines that do not make a profit, they have more of a public health character”, says Monica De Bolle, professor of economics at Johns Hopkins University and master in Immunology and Microbiology from Georgetown University.
“And there is another factor: antibiotics [ou antifúngicos] they are produced using the natural resistance that other microorganisms have against the organisms they wish to attack. This is the case with penicillin, which uses a substance produced by a fungus to prevent bacterial growth. Research that investigates new substances found in nature for use in medicines is expensive and, in general, time-consuming”, he adds.
